Sleep and Health. Tiina Paunio Professor of Psychiatry, Research Professor. Tekes: Health Tuesday

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1 Sleep and Health Tiina Paunio Professor of Psychiatry, Research Professor Tekes: Health Tuesday

2 How did you sleep last night? How do you feel at the moment?

3 Why do we sleep? Sleep has an important role in health and well-being throughout life Restoration of the energy resources Multiple functions Regulation of emotions Restoration of synaptic homeostasis (learning, memory) Removal of waste products in brain

4 How did you sleep last night? Well / quite well Too short sleep Poorly / quite poorly Difficulties falling in asleep Frequent nocturnal awakenings Early morning awakenings Nonrestorative sleep Sleep insufficiency How do you feel at the moment? Alert / Tired Mood: normal / irritated or lowered Ability to concentrate: good / difficulties

5 Sleep need varies between individuals Environment Genome

6 What happens when sleep is deprived? Acute sleep deprivation Low-grade inflammation Deviation in energy metabolism Neurobehavioral consequences Chronic sleep deprivation Increased risk for somatic and psychiatric diseases

7 Poor sleep increases risk for disability retirement due to depression twins, followed

8 Poor sleep increases risk for disability retirement due to any cause 5986 employees of the city of Helsinki, followed * HR = 2.44 (1.37,4.35) for Musculoskeletal Disorders HR = 3.71 (1.29, 10.69) for Mental Disorders * Lallukka et al, Am J Epidemiol 2011

9 Increasing trend for insomnia among the working population Kronholm et al, JSR 2008

10 Increasing trend for insomnia among adolescents Girls Sample: adolescents aged years ( ) Finnish School Health Promotion Study and the Health Behavior in School-Aged Children study 2x increase in insomnia symptoms and tiredness from mid- 1990s to yr 2008 Girls > boys Boys Association with lower school performance A widening gap in school performance btw normally vigilant / chronically tired pupils

11 Mechanisms for insomnia: Neurobiological model Overactivity of the arousal system Nofzinger, 2004 the hormonal stress system

12 Mechanisms for insomnia: Cognitive model (Harvey) Increased arousal Distress Excessive anxiety Dysfunctional beliefs Selective attention for threat cues Overestimation of sleep deficit

13 Insomnia in occupational context: a vicious circle Work-related risk factors: Low control on work High work demands Poor social support Bullying Effort-reward imbalance Organizational injustice General risk factors: Stress Early environment Personality Genetic factors Insufficient/ poor sleep Mood, cognitive and social performance Risk for psychiatric and somatic diseases Absenteeism Occupational injuries Imbalance btw work demands and functional capacity Lower job satisfac tion Maladaptive compens atory behavior Disability pensions Paunio et al, Psychiatria Fennica, 2015

14 How is sleep regulated? Two-process model: both time awake (H) and the circadian time (C) matter External zeitgebers affect C H is modified by the daily activity Homeostatic and Circadian regulation (Borbely)

15 NREM How can sleep be measured? Awake REM Awake Objective data Polysomnography (sleep structure) Measuring of motor activity with f.ex. actigraphy (timing and quantity of sleep, no precise information on sleep structure) FIgs: Paunio and Porkka-Heiskanen, Duodecim 2008 Sleep length (h) Subjective data Questionnaires Sleep diary

16 How can quality of sleep be improved? Ask: 1. Poor sleep - what does it mean? 2. How is the sleeping environment? 3. Life habits and daily rhythm? Find solution(s): Cure an underlying problem/illness Simple educational and behavioral methods Cognitive-behavioral psychotherapy, mindfulness (Medication) ((Experimental: Induction of deep sleep via auditory or other stimuli))

17 Increase of slow-wave activity via acoustic stimulation (SDS Project) Initial study: Ngo et al. (2013) SDS: Development of a simplified, automatized protocol for sound stimulation during NREM sleep 50 ms long 1/f noise burst ( of 15 db above the hearing threshold) Effects of the stimulation on different memory type specificity, subjective sleep quality and mood

18 Did you dream last night? Do you frequently see nightmares?

19 What are dreams? Internal experiences during sleep Intensity and vividness relates to rapid eye movements (f.ex. Hong,1997) Dreaming takes place both during NREM and REM sleep The precise neural correlates are still largely unknown

20 Neurophysiology of dreaming The three stages of consciousness (Wake, NREM and REM sleep) can be distinguished by the internal Default Mode Network (DMN) activity of the brain DMN during REM sleep is partially similar to that during wake NREM/N3: Functional uncoupling of the anterior and posterior nodes of DMN REM: Recoupling of the anterior and posterior regions of DMN, but there is more widespread dynamic interaction btw sensorimotor areas and the association cortices

21 Why do we dream? Dreams are often quite logical by their structure & may comprise repetitive themes -> unlikely to be sporadic noise Reorganizing and reprocessing of emotional experiences (?)

22 Nightmare: a dysfunctional dream? Nightmare: a vivid and frightening dream that awakens the dreamer Connected to traumatic experiences, affective coping, and night-time emotional reprocessing

23 Prevalence of nightmares in adult population: differences btw men and women A sample of people (Finrisk) from During the past 30 days, have you had nightmares often / sometimes / never?

24 Prevalence of nightmares in adult population: increased prevalence among the war veterans

25 What do nightmares associate with? Finrisk, participants Frequent nightmares occur more often among the short and long sleepers

26 What do nightmares associate with? Strongest risk factors for frequent nightmares: Negative attitude toward the self Insomnia (OR 6.90) Exhaustion and fatigue (OR 6.86) Headache (OR 4.1) Self-reported impaired ability to work (OR 3.13) Frequent heavy use of alcohol (OR 2.52) c

27 To conclude, The importance of sleep has only quite recently been acknowledged in clinical medicine However, sleep does not only reflect the daily states of mind or body, but has a direct effect on health Chronic insomnia and frequent nightmares are associated with negative health outcomes Every-day advice for good sleep: have a good quality of your time awake & keep your rhythm stable!

28 Acknowledgments National Institute for Health and Welfare Erkki Kronholm Tiina Laatikainen Hanna Ollila Anna Sofia Urrila Riikka Puustniekka University of Turku Antti Revonsuo Nils Sandman Katja Valli Kela Karoliina Koskenvuo University of Jyväskylä Jukka Jokela Jari Villberg Raili Välimaa Jorma Tynjälä University of Helsinki Jaakko Kaprio Tellervo Korhonen Markku Koskenvuo Tarja Stenberg Vitalmed Markku Partinen Institute for Occupational Health Christer Hublin Minna Huotilainen Mika Kivimäki Miika Leminen Kiti Muller Teemu Paajanen Emma Saure Jussi Virkkala Northwestern University, Chicago Giovanni Santostasi Phyllis Zee