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1 Boa tarde No conflict of interest Um prazer e uma honra estar em Portugal
2 SLEEP QUESTIONS Leonardo Fuks MD Rabin medical center Israel
3 OSA OBSTRUCTIVE SLEEP APNEA MILD 5-15 MODERATE > 15 < 30 SEVERE > 30
4 60 AHI O2 SAT RA 78% What to do? OSA 3
5 OSA 3 To lose weigh Difficult EXERCISE Difficult ENT Cpap\bpap
6 WHY TO TREAT? FATIGUE CONCENTRATION MEMORY ARRHYTMIAS DIABETES CAR ACCIDENTS OSA 3
7 OSA 3 STROKE SHALOM\ PEACE
8 OSA 3 DENTAL DEVICE?
9 INSOMNIA PRIMARY 3 WEEKS ACUTE MAIN PROBLEM INSOMNIA SECONDARY MORE THAN 3 WEEKS CHRONIC OTHER PROBLEMS
10 Insomnia Medical (pain / inflammatory dis etc.) Mental (depression, anxiety) Iatrogenic (medications) Inadequate sleep hygiene Idiopathic insomnia Psychophysiological insomnia Sleep State Mispeception Melatonin deficiency (circadian)
11 Short sleepers X Long sleepers
12 Sleep duration and disease <6 Hours/Day >8 Hours/Day Morbidity and mortality insomnia ~7hours/Day Sleep hours
13 Insomnia causes insulin resistance Effects of sleep deprivation and exercise on glucose tolerance. It is suggested that sleep deprivation contributes to the development of an insulin resistance that can be partially reversed by physical activity. The results support the suggestion that Sleep deprivation results in decreased insulin sensitivity at peripheral receptor sites which can eventually lead to insulin exhaustion at pancreatic sites after longer periods of SD VanHelder T et al. Aviat Space Environ Med. 1993; 64:487-92
14 Insomnia and mortality Increase of 15% in the mortality mortality +33% +17% +7% +19% +17% +11% SLEEP, Vol. 31, No. 4, 2008
15 Choice Not to sleep without pills To sleep with pills?
16 Medications? Sleep hygiene? CBT? Insomnia 1
17 Recommended behavioral practice Psychosocial intervention Old drugs, side effects, addiction Older than 55 y Sleep hygiene CBT Benzodiaze pines Melatonin More specific. Less side effects. No addiction Non-BZ Maintain sleep architecture Non-BZ Cr
18 Siesta Rapid transformation adenosine to ATP Not for patients with insomnia Rapid turn into REM sleep People wake up full of energy
19 Siesta Good for some people Not for insomniacs
20 Melatonin Melatonin deficiency With age production decreases Pineal gland calcified Prolonged-Release Melatonin 60 y old since last year I have insomnia good candidate.
21 Melatonin Production Decreases 6-sulfatoxymelatonin [ng/h] with age y (n=26) ** y (n=17) y (n=16) ** > 65 y (n=16) ** 11pm-7am 7am-11am 11am-6pm 6pm-11pm 11pm-7am Mahlberg et al. Psychoneuroendocrinol 2006
22 Prolonged-Release melatonin 2MG day Take a lot of time When it works, it works
23 Sleep pills fear We need to sleep New generation Less side effects / tolerance
24
25 Benzodiazepines side effects Tolerance \ dependence Addiction Disrupts sleep architecture Hangover Falls Amnesia Car accidents
26 Zolpidem cr For those who awake in the middle of the night
27 No dependence No tolerance Less side effects Z DRUGS
28 Better together? No MONOTHERAPY For example CIPRALEX anxiolytic awakening in the morning and ZOLPIDEM CR by night
29 Sleep drugs side effects Unnatural sleep? Addiction? Tolerance? Bad sleep? Side effects
30
31 Good partners BZ and prolonged- release melatonin Cipralex and Z drug
32 Z + BZ Less reasonable
33 Not to sleep without pills High risk to diseases Sleepy during the day Quality of life To sleep with pills? Fall asleep Less side effects Low risk of addiction Life expectancy
34 BOA NOITE OBRIGADO DURMAM BEM DR LEONARDO FUKS
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