Sleep and Executive Performance
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- Roderick Williamson
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1 Sleep and Executive Performance 2017 United Fresh Produce Executive Development Program Ana C. Krieger, MD, MPH, FAASM, FCCP Medical Director, Center for Sleep Medicine Associate Professor, Weill Cornell Medical College Associate Attending, New York Presbyterian Hospital & Rockefeller University Hospital
2 Optimizing Health BRAIN HEALTH Responsible for coordinating all physical and mental activities Training Nutrition REST = Proper Sleep
3 Quiz # 1 Which functions are regulated by sleep? a. Immune system b. Hormonal c. Cognition (memory, attention) d. Mood e. All of the above
4 Functions of Sleep Cognitive Function Attention/Vigilance Memory Decision making Reaction time Immune Regulation Hormonal Balance Mood Regulation
5 Executive Function and Lack of Sleep Falleti, 2004
6 Cognitive Effects of Lapses Short Sleep Duration Van Dongen, 2013
7 DST (Spring) and Reaction Time Average 10% slowing in speed of response Effect lasted for several days DST = Daylight Savings Time Krieger, 2015
8 Fatigue Physical Mental Irritability Headaches Jet Lag Fragmented sleep Decreased appetite Gastrointestinal problems Lancet 1997, 2007
9 Sleep Loss and Immune Response n= sleep deprived vs. normal sleep Lange T, 2011
10 Sleep and Appetite
11 Short Sleep and Obesity Cappuccio, 2008
12 Mood and Sleep Losing patience or yelling at children/partner 30% 51% Lacking interest, motivation or energy 30% 42% Feeling overwhelmed 27% 40% Feeling irritable or angry 32% 45% At least 8 hours of sleep (n=1374) Less than 8 hours of sleep (n=576) National Sleep Foundation, 2013
13 Journey to Optimizing Sleep Timing Duration Quality
14 Sleep Rhythm - Timing
15 Sleep Pacemaker Cells Synchronized to day/night Self-sustained oscillations Connected to the brain melatonin release Connected to the body by peripheral oscillators
16 Sleep Physiology REM Sleep REM Sleep
17 Integration of Wake/Sleep Cycles
18 Timing of Sleep A Circadian Rhythm Light Delayed Advanced (sleep period) 12 noon 3 pm 6 pm 9 pm 12 MN 3am 6 am 9 am 12 noon Time of day (hr)
19 Elsevier, Principles and Practices of Sleep Medicine
20 Shift Work and Health Problems Poor sleep quality Headaches Pre-term/low birth weight children Hormonal abnormalities Increased FSH/LH/Estradiol Decreased Melatonin Increased risk for Cancer * Breast, Prostate, Colon Increased risk for CV Disease *dose-effect: >15 y of 3+night shifts/month Hansen, 2012 Knutsson, 2012 Bonde, 2012
21 Quiz # 2 How much sleep do you typically get during the weeknights? a. Less than 6 hours b. 6 to 7 hours c. 7-8 hours d. More than 8 hours
22 Sleep Deprivation in the U.S. 35 % Sleep Duration 6 hours/night 70 million adults National Health Interview Survey
23 Sleep Duration Over the Past 50 Years in the U.S. hours % 40 Home and Office Computers Handheld Devices National Sleep Foundation
24 Causes of Sleep Loss Schedule Worries -? About sleep Leisure Use of Electronic Devices Effect on MELATONIN
25 Sleep and the Environment Royal Astronomical Society and NASA
26 CV and All-Cause Mortality Sleep Duration N = 98,634, 14 y f/u Multivariable Hazard Ratio Ikehara, 2009
27 Ideal Sleep Duration Individual Variation Recommended duration: Adults (26-64): 7-9 hours (6-10 h) Older Adults (65+): 7-8 hours (5-9 h) It is estimated that < 1:1,000 can function effectively on 6 or fewer hours of sleep Genetic Basis: Per, CLOCK, CRY, BMAL genes National Sleep Foundation, 2015
28 Sleep Problems in the U.S. % Insomnia Sleep Apnea Restless Legs/Limb Movements Men Women National Sleep Foundation 2011, 2014
29 Sleep Disturbances Awareness
30 Obstructive Sleep Apnea (OSA)
31 Health Effects of OSA Daytime sleepiness Diabetes Cardiac Disease OSA HTN Motor vehicle accidents $3.4 billion estimated annual health care costs in the US are associated with undiagnosed OSA Stroke Cognitive dysfunction Kapur V, et al. Sleep. 1999;22:
32 Problems Associated with Sleep Apnea Daytime functioning: Sleepiness - risk for car accidents is doubled Fatigue Increased risk for: Heart Disease: HTN 2x risk Stroke and Arrhythmia 4 x risk Death Possibly Cancer
33 3 Performance Deficits in Sleep Apnea OSA Effects Pathways Global Executive Memory Attention/Vigilanc e Psychomotor Fine motor Hypoxemia Hypoxemia Arousal Arousal and hypoxemia Hypoxemia
34 Treatment for Sleep Apnea Several modalities have been shown effective * in treating apnea, including: CPAP or similar equipment Oral appliances Airway surgery Avoidance of back-position during sleep Weight loss * Variable degrees of efficacy
35 Effects of CPAP on Mortality n = 871, severe OSA Survival 96.4% (94,98) 91.3% (88,94) 85.5% (78,92) 46 deaths (19 CVD, 16 Cancer) Campos-Rodriguez, 2005
36 Weight Loss and Sleep Apnea Mean decrease in AHI was 19 events/hour 24% Pre 32% Post Pre Post BMI (kg/m 2 ) AHI (events/hour) Krieger, 2012
37 Sleep Apnea Treatment and Daytime Functioning n = 107, randomized Moderate and Severe OSA 1 month follow-up
38 Screening for Sleep Apnea S - Do you SNORE loudly (louder than talking/closed doors)? T - Do you often feel TIRED, fatigued, or sleepy during daytime? O - Has anyone OBSERVED that you stop breathing during sleep? P - Do you have or are you being treated for high blood PRESSURE? BMI more than 35kg/m 2 Age over 50 years old Neck circumference > 16 inches (40cm) Gender: Low risk: Male 0 2, Intermediate risk: 3 4, High risk: 5-8 Chung 2008, 2013; Boyton 2013; Cowan 2014; Kumisaki 2014
39 Restless Legs during Sleep Affects 5-10 million Americans Decreases quality of life Increases risk for mood disturbances Increase risk for cardiovascular disease
40 Sleep Disorders Disease Specific Risk Sleep Apnea Insulin Resistance/Diabetes Neurocognitive Changes /? Dementia Hypertension CV Disease: Atrial Fibrillation/Stroke Death Leg Movements Mood disorder CV Disease
41 Quiz # 3 How often can you say that you have a good night of sleep? a. Almost every night b. A few nights a week c. A few nights a month d. Rarely/almost never
42 Sleep Quality National Sleep Foundation, 2012
43 Insomnia Difficulty Falling Asleep Difficulty Staying Asleep Early Morning Awakening Unrefreshing Sleep Potential Causes: stress, worries, anxiety, poor habits, increased light exposure, warm temperatures, mismatched bedtime, other sleep disorders
44 Insomnia and Hypertension Predictors OR (95% CI) Normal sleep 6 h 1.0 Chronic insomnia 6 h 0.85 ( ) Normal sleep < 6 h 0.88 ( ) Chronic insomnia < 6 h 3.75 ( )* n = 786, adjusted for sex, race, age, caffeine, cigarettes and alcohol consumption, depression, sleep-disordered breathing, diabetes mellitus, body mass index 30, and baseline blood pressure Fernandez-Mendoza, 2012
45 Insomnia Self-Medicating % with insomnia Overall Alcohol OTC Rx meds Ancoli-Israel et al. 1999
46 Sleep Across Life Cycles Adolescence, Pregnancy, Menopause With Ageing: Sleep Fragmentation Frequent awakenings at night Increased Daytime Sleepiness More tendency to nap Higher Rates of Sleep Disorders
47 Quality of Sleep and Medications Heart medications Anti-depressants Cholesterol lowering agents Asthma and Allergy medications Steroids Pain medications
48 Sleep and Food Alcohol Caffeine Nicotine Chocolate Oatmeal Cherries Banana Milk
49 The Ultimate Home Office
50 How Can You Sleep Better? Create a cozy bedroom environment - room temperature between 65 and 70 F Use Personalized approaches
51 What Can You Do? Optimize Your Sleep Timing Identify your best sleep timing (biological) Keep a regular sleep schedule Avoid changing it > 2 hours on weekends/travels/days off Track your sleep*
52 Consider a Sleep Diary
53 What Else Can You Do? Optimize Your Sleep Duration Avoid stimulating activities during the min prior to sleep f.lux Avoid increasing your body temperature before going to sleep Avoid worries/stressors at bedtime using relaxation techniques
54 Any Other Suggestions? Optimize Sleep Quality Screening for Sleep Apnea Evaluation for RLS or other sleep disturbances
55 If Sleep Problems Persist Discuss any sleep concerns with your doctor If needed, get tested for a sleep disorder AVOID WORRYING ABOUT SLEEP!
56 Weill Cornell Center for Sleep Medicine
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