Women and Sleep: From Stressful to Restful 11/13/12. Kathryn Lee, RN, CBSM, PhD, FAAN

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1 BIOGRAPHY: Women and Seep: From Stressfu to Restfu 11/13/12 Kathryn Lee, RN, CBSM, PhD, FAAN Dr. Kathryn A. Lee is a Professor of Nursing in the Department of Famiy Heath Care Nursing at UCSF. She hods the James and Marjorie Livingston Endowed Chair in Nursing and is the Associate Dean for Research in the Schoo of Nursing. She competed her PhD training at University of Washington in 1986 and was a Robert Wood Johnson Cinica Nurse Schoar from She is board certified in Behaviora Seep Medicine and an eected Feow in the American Academy of Nursing. She is a past member of the Seep Research Advisory Board in the Heart, Lung and Bood Institute at the Nationa Institutes of Heath. She is currenty an Associate Editor for the journa, Behaviora Seep Medicine, and on the Editoria Board of Seep Medicine Reviews. She has authored over 150 pubications reated to seep and women s heath. Dr. Lee has no confict of interest to decare. BIBLIOGRAPHY: Baker FC, Wofson AR, Lee KA. Association of sociodemographic, ifestye, and heath factors with seep quaity and daytime seepiness in women: findings from the 2007 Nationa Seep Foundation "Seep in America Po". J Women s Heath. 18:841-49, Castro CM, Lee KA, Biwise DL, Urizar GG, Woodward SH, King AC. Seep patterns and seep-reated factors between caregiving and non-caregiving women. Behaviora Seep Medicine. 7:164-79, Kim KH, Lee KA. Seep and fatigue symptoms in women before and 6 weeks after hysterectomy. J Obstet Gyneco Neonata Nurs, 38:344-52, Beddoe AE, Yang C-P, Kennedy HP, Weiss SJ, Lee KA. Effects of mindfu-yoga on seep in pregnant women: A piot study. Bio Res Nurs. 11: , Lee KA, Moe K. In Kryger, MH, Roth, T, and Dement, WC. (Eds.). Seep and Menopause. Principes and Practice of Seep Medicine. Chapter 140, pp Phiadephia: Esevier Saunders, 5 h Edition, Lee KA, Rosen LA. In Morin, C and Espie C. (Eds.). Seep and Human Deveopment. (Chapter 4, pp ). Oxford Handbook of Seep. Oxford University Press, 1 st edition, Lee KA. Introduction to specia issue: Women as participants in seep research. Behaviora Seep Medicine. 10:

2 Women and Seep: From Stressfu to Restfu Objectives Describe heathy seep patterns across the ife span. Kathryn Lee, RN, PhD, CBSM, FAAN Professor and Associate Dean for Research Famiy Heath Care Nursing Discuss bio-psycho-socia heath effects of seep oss. Research supported by Nationa Institutes of Heath (NR02247, NR03969, NR04259, NR05345, MH074358) Discuss heathy seep hygiene interventions to improve seep. Seep Lab Studies Typica Adut Seep There s no pace ike home... Nationa Seep Foundation Pos (1998, 2003, 2007) Women report seeping about 6.5 hrs/night. Women report seeping 8-13 more minutes per night than men, but More women (63%) compain about insomnia than men (54%) More women (20%) have daytime seepiness than men (13%) 1

3 Methodoogy How do you respond to this warning? Teephone survey of 1,003 American women aged iving in the US 25-minute survey Sampe is representative of househods with a teephone in the US Data coected between 9/12/06 and 10/28/06 Margin of error: +/- 3% (95% CI) Seep in America Po (N=1000 women) (Baker, Wofson & Lee, J Women s Heath, 2010) Working mothers: 72% compain of insomnia Highest caffeine use (56% ) average 2.7 cups/day Highest rate of drowsy driving (35%) 50-somethings: Highest use of seep aids (41%) Gender Differences Is it a biased perception/reporting issue? Is it famiy care/roe responsibiities? Is it someone ese s seep disorder? seep apnea in the adut bed partner parasomnias in the chid (night terrors) waiting for the phase-deayed teenager to come home at night with the car Nationa Seep Foundation 2007 Women & Seep Po 20% are awakened by a chid and 9% seep with chidren 17% are awakened by a pet and 14% seep with a pet Framework for Seep Loss and Heath Lee, et a, 2004 Nsg Outook Insufficient Seep age/deveopment ife stye seep oss Fragmented Seep seep disorders (apnea) acute and chronic iness (rena, pumonary, g.i.) Adverse Heath Outcomes Physioogica immune function, fat/gucose metaboism Cognitive/Behaviora fatigue, impaired memory, accidents Socia poor socia/famiy interactions 2

4 Seep & Immune Function Seep deprivation can imit effectiveness of a fu shot: Hepatitis A Vaccination Lange et a (2003) Fu shots to 2 groups of heathy young men: one group - seep ony 4 hrs/night for 4 nights other group - sept normay 10 days after vaccination: seep-deprived group produced fewer than haf as many fu-fighting antibodies (Spiege, et a. Effect of seep deprivation on response to immunization. JAMA, 2002) Simiar resuts with hepatitis A vaccination (Lange, et a. Seep enhances the human antibody response to hepatitis A vaccination. Psychosom Med, 2003) Open circe - reguar seepers the night after vaccination Fied circe - kept awake on that night Seep and Pregnancy Outcomes* Tota Seep Time 7+ hrs (n=74) 6 6.9hrs (n=38) <6 hrs (n=19) Lee & Gay, Obstet Gyneco, 2004 Labor (hrs) C/S OR 95% C.I % ref % (p=.012) % (p=.014) *controed for birth weight Framework for Seep Loss and Heath Lee, et a, 2004 Nsg Outook Insufficient Seep age/deveopment ife stye seep oss Fragmented Seep seep disorders (apnea) acute and chronic iness (rena, pumonary, g.i.) Adverse Heath Outcomes Physioogica immune function, fat/gucose metaboism birth outcomes (ength of abor, cesareans Cognitive/Behaviora fatigue, impaired memory, accidents Socia poor socia/famiy interactions Seep Loss: Accidents & Errors Costs to Society Affects miion Americans Adds $15 biion to nationa heath care IOM - estimates that drowsy driving is responsibe for 20% of motor vehice crashes drowsy driving causes 1 miion crashes and 8,000 deaths each year in the U.S. 24 hrs of continuous wake induces impaired performance equivaent to a bood-acoho eve of 0.10% (ega imit for acoho intoxication in the USA is.08%) Midife: Time of Transition Midife = years of age Some are starting famiies, others are grandmothers Some chidren have eft home, other adut chidren are returning home (boomerangs) Caregiving for spouse or eder famiy members Caring for both chidren & eders (sandwiches) 3

5 Menopause = estrogen insufficiency Hot Fashes and Seep most common symptom associated with estrogen insufficiency: hot fash, fush, night sweat PSG Stage 0 Peri-menopausa (n=12 no symptoms) 10% Peri-menopausa (n=20 symptoms) 13% Shaver, Gibin, Lentz, & Lee, Seep 1988 Non-fashers (n= 7) 5% Fashers (n= 12) 10% Woodward & Freedman, Seep 1994 Hormone Repacement Therapy HRT in randomized cinica trias: No change in seep stages Reduced symptom compaints Low incidence of periodic eg movements Low incidence of seep disordered breathing/apnea Montpaisir, et a 2001 Menopause: J North American Menopause Soc. 2 nights PSG baseine and 6 month foow-up; n=21 postmenopausa Purdie, et a 1995 Brit J Obstet Gynec 12 wks pacebo or 12 wks HRT; PSG 1 night every other wk; n=33 Freedman & Roehrs, Fertiity Steriity 2004 Symptomatic group had (1-18) hot fashes/night 6 asymptomatic women had hot fashes Comparing symptomatic and asymptomatic women yrs of age: No differences on seep (nights 2 & 3) No differences on questionnaires San Francisco Longitudina Midife Study Co-Investigators To describe women s seep over time, from pre-menopause to post-menopause, in reation to bio-psycho-socia-cutura factors (every 6 months for 3-4 years): Yewoubdar Beyene, PhD Catherine Giiss, RN DNSc Yoanda Gutierrez, PhD, RD John Neuhaus, PhD UCSF Anthropoogist Yae Famiy Heath UCSF Nutritionist UCSF Statistician FSH eve diet, exercise, smoking, & body weight stress and emotiona heath famiy and socia reationships NIH R01 NR04259 Office of Women s Heath Suppement 4

6 Methods Community-based sampe of heathy reguary menstruating women Live in US at east 20 years years of age Perceived seep quaity not significanty different for: PSQI Women with chidren (58%) Women without chidren (42%) Empoyed women (86%) Unempoyed women (14%) Nocturia or hot fashes Exercise Acoho/caffeine Low fat diet NS NS NS NS Correates of Perceived Seep: Late-Premenopausa Women Perceived seep quaity was worse for: PSQI Singe women (47%) (p=.005) Married/Partnered (53%) Smokers (22%) (p=.01) Non-smokers (78%) African Americans Late Pre-menopausa Subjective Seep PSQI* *(p<.001) Wk day (hrs)* Wk end (hrs)* African Am (89) Euro Am (163) Latinas (94) Actigraphy Exampe: hot fashes Tota Seep Time (minutes) Late Pre-menopausa Objective Seep Time 2 Time 3 Time African Amercan Euro American Latinas 5

7 A Bio-Psycho-Socia Framework for Predicting Seep Compaints in Midife Women (n=347) Summary: Midife Women Bioogica Factors 1% Age/FSH Body weight/diet Smoking Exercise * Psychoogica Factors 30% Depression* Stress Socia factors 4% Supportive reations Mutipe roes (wife, mother, empoyee) Ethnicity* Education* Seep Compaints 36% > 5 PSQI Litte is known about women's seep in the decade prior to menopause or how seep is atered during menopausa transition. Psycho-socia factors may pay a arger roe than hormones and other physioogica factors. Women sef-report more probems with seep than men, but objective measures (PSG, actigraphy) are simiar. What is Sufficient for a Good Night s Seep??? The average person needs 7-8 hrs Varies consideraby from person to person Seep oss of as itte as 1.5 hrs can decrease daytime aertness by 33% How Much Seep Do You Need? The amount that permits you to be awake, aert, and energetic throughout the day When to Be Concerned Pinea Gand and Meatonin Longer than 30 minutes to fa aseep on 3 or more nights/week. 3 or more awakenings at night. Faing aseep during the day. Bed partner reports: excessive imb movements, oud snoring or cessation of breathing. 6

8 Chrono-type: OWL or LARK? Seep in America Po (N=1000 women) (Baker, Wofson & Lee, J Women s Heath, 2010) 50-somethings: Highest use of seep aids (41%) Using Benzodiazepines (seeping pis) faciitate seep onset and reduce fragmented seep hepfu when other remedies are not effective can aggravate seep-reated breathing disorders (seep apnea) Ony work for a short time Can have hang over effects Seeping Pis: Benzodiazepines Side effects incude: Daytime seepiness Sedation Toerance Depression Memory impairment Hacion (Triazoam); Restori (Temazepam) Short-Acting Non-Benzodiazepines Repace those seeping pis with Ambien (Zopidem) Sonata (Zaepon) Lunesta/Estorra (Eszopicone) Rozerem targets meatonin receptors in the brain Seep Hygiene 7

9 Seep Hygiene Intervention Seep Hygiene: Seeping B. E. T. T. E. R. B. Bedroom Comfortabe bed Safe/secure room Coo rather than warm Dark rather than ight B. E. T. T. E. R. E. Eating A protein snack in the evening Avoid caffeine, especiay within 4-6 hrs of bedtime Avoid acoho, especiay before bedtime B. E. T. T. E. R. T. Tension Reax prior to seep Soothing warm mik Warm bath Good book B. E. T. T. E. R. T. Time in bed trying to seep B. E. T. T. E. R. E. Exercise If you can t get to seep, get up and go somewhere ese If you wake up eary, get up and get going Have some type of physica activity in the morning or afternoon Avoid heavy physica activity 2-3 hours before bed 8

10 B. E. T. T. E. R. R. Rhythm Keep a consistent daiy rhythm for Eating Socia activities Seeping Light exposure Heathy Peope 2020 Nationa Objectives Provides 10-yr US objectives for promoting heath and preventing disease. Proposed objectives that pertain to seep and seep disorders: Increase proportion of teens obtaining adequate seep Increase proportion of aduts obtaining adequate seep Decrease number of motor vehice incidents attributed to drowsy driving Questions???? NATIONAL SLEEP FOUNDATION Increase the proportion of aduts with apnea symptoms seeking medica treatment 9