1. Sleep,
Manisha Witmans, MD, FRCPC, FAASM
Brainworks Conference 2013

2. Conflict of Interest
• Previous sleep and research funded by: AIHW, CIHR
• Medical Director: Sound Sleep Solutions
• Consultative Services for Stollery Children’s Hospital
and Department of Pediatrics, Sleep Medicine and
interpretation of ambulatory home testing

3. Objectives
• To dispel common myths about sleep
• Provide practical tips about good sleep
• Resources for sleep

4. Myth
Sleep is a Waste of Time

5. The Evolution
• Thomas Edison: “Sleep is a criminal waste
of time and heritage from our cave days”
• Margaret Thatcher: “Sleep is for wimps”
• Money does not sleep!
• It is not an upgrade option…
BUT SLEEP IS NOT THE ENEMY, WE ARE!!!

6. Sleep is VITAL
• 90 yr old = will sleep 32 years (36% of lifetime)
• Infant – first year – at least ½ of her/his life sleeping
• It is as important as AIR and WATER for SURVIVAL!
• Historically, we knew its importance…not why

7. Why We Sleep?
• For Restoration
– Genes turned on during sleep
– Slow wave sleep
• Energy Conservation
– Only 110 calories saved from not sleeping
• Brain Processing and Memory Consolidation
– Enhances creativity by 3 fold – synaptic connections strengthened….
– Brain development - critical
• Overall – mental function, immune function, growth and tissue repair

8. Sleep-Wake
Continuum
SLEEP
WAKE

9. Sleep IS Important
Sleep deprivation can cause:
• Impaired cognitive, social and behavioral performance
• Poor school performance and lower grades
• Tardiness and absence from school/work
• Difficulty remaining alert, less ability to concentrate
• Irritability and impaired mood
• Increases in substance abuse
• Drowsy driving, injury and possibly, death
– Being sleep deprived is as dangerous as DRUNK DRIVING

10. Sleep
Dysfunction:
Conceptual Framework
Insufficient Sleep
(Sleep Deprivation)
Fragmented Sleep
(Sleep Disruption)
Excessive Daytime Sleepiness
Primary Disorders
of Excessive Daytime
Sleepiness
Circadian Rhythm
Disorders

11. Perception of Sleep Deprivation
Slide
courtesy
of
Dr.
Ruth
Benca

12. Myth
Sleep loss does not affect me
I can make up for sleep deprivation
….6450, 6451,
6452….
I think I can…..
I think I can…..
I think I can…..

13. Sleep
Deprivation/Loss
• Weight gain (50% chance of obesity at 5 hrs of sleep) –
– Less loss of fat when dieting if you don’t sleep well (Van Cauter,
Sleep, 2012)
– Risk of obesity with sleep loss in children (Chaput, J Public Health,
2011)
– Increased risk of obesity with sleep fragmentation (Narang, CMAJ,
2013)
• Injury
– 86% increase in risk for injury in 3-5 yr old with < 10 hrs of sleep per
night the night before the accident (boto LR, Sleep Medicine, 2012)
• Risk taking behavior
– Teens - More likely to gamble (Beebe, 2012)

14. Sleep Deprivation
• Average sleep time 2013: 6.5 hrs
• Current sleep time 2013: 5 hrs
• The “at risk”: shift work, teens, jet lag, etc.
• Microsleeps: your brain coping: 31% drivers
will fall asleep at the wheel at least once in
their life… can be deadly!!!

15. Sleep
INCREASES/IMPROVES:
• Attention
• Concentration
• Creativity
• Ability to socialize
• Decision making
• Mental health
• Physical health
DECREASES:
• Mood changes
• Stress
• Impulsiveness
• Fatigue
• Anger
• Inattention
• Risk taking behaviour (drink
and take drugs)

16. Drowsy Driving
and Auto
Accidents
• The peak age for fallasleep driving
accidents is 20 years
www.car-accidents.com/pages/accident_story/3-8-04.html

17. Myth
Sleep, Oh Beautiful and Perfect Sleep

18. Reality: Shame and Blame
•
•
•
•
•
•
•
Bedtime troubles is __________’s fault!
S/he will outgrow it
I am the only one affected by it….
I need to take care of the other stuff
I must be doing something wrong
There must be a magic pill
Nobody listens or can help

19. The facts:
• Bedtime troubles are common in children
– Increased likelihood if developmental disabilities
– Can become lifelong
• Over the counter preparations, although have
sleepiness as a side effect may not address the
underlying reason for the sleep problem
• It is best to work with a health professional
knowledgeable about sleep to address the concerns

20. The facts:
• Alcohol and caffeine are not sleep aids. They
disrupt sleep
• Medications in adults do exist but even for
them recommended for short term and in
conjunction with behavioral strategies
• More is not always better – melatonin…

22. Social
pressures
School start
times
Substance
abuse
Delayed sleep
phase
Slee
p
Time
Genetic
predisposition
Hormonal
influence,
obesity

23. Slide courtesy of Jodi Mindell

24. Myth: Giving In
• It’s late and I am tired, many nights of this
and I will give in….have the kid come to
bed….

25. The Facts:
• Pick your battles
• Timing can be critical and use it to your
advantage
• This about gains in small increments
• Rome was not built in a day

26. Myth
Electronics before bed are okay

27. The Facts:
• Sleep will be more agitated and can hinder
sleep quality
• Children stay up longer, sleep less, and wake
up more
• The bedroom should only be used for sleep
• The bedroom should be a sanctuary

28. Myth
Snoring is normal

29. Snoring is NOT Normal
• Snoring can be a sign that a child/adult has
sleep apnea
– Anyone can be affected
– Can present as:
• Increased work of breathing
• Apneas (holding breath during sleep)
• Waking up tired/daytime irritability
• Social/Marital/Academic Problems
• Risk of injury

30. Snoring is NOT Normal II
• Risk Factors:
– Big tonsils and adenoids (children)
– Asthma
– Allergies
– Family history
– Facial features (small jaw, big tongue)
– OBESITY
– Non-Caucasian

31. Myth
Watching television helps me fall
asleep

32. Data About Television and Sleep
• Preschool children that watch television before bed
have:
– More disrupted sleep
– More nightmares
– More awakenings
– More bedtime resistance
• Can cause behavioral sleep issues in children

33. Myth
I can do whatever I want before
bedtime and sleep well

34. RESULTS: cravings – drugs, stimulants, caffeine,
nicotine, alcohol – uppers and downers… an
attempt at control…

35. Myth: Sleep Aids = Training Wheels
• Training Wheels:
– Wibble Wobble Method: Doug Engelbart
• See-saw back and forth
• Feel for the relationship between tilting, steering and
untilting and refining the motion while moving forward

36. • Recommended Maximum Caffeine Intake
Levels for Children (Health Canada)
4 - 6 years 45 mg/day
7 - 9 years
62.5 mg/day
10 - 12 years 85 mg/day
Many other ‘hidden’ caffeine sources.

37. Clues to Increased Need for Sleep
•
•
•
•
•
•
Need an alarm clock to wake up daily
Excessive use of stimulants
Need or take naps
Falling asleep at unexpected times/situations
Sleeping in on weekends
Noticeable change in ability to function when
given opportunity to sleep

38. Getting Enough Sleep
• Nightly sleep needs:
– Most adults need 6-8 hrs
– Most children age 8-12 yrs need 9-11 hrs
– Most teenagers need about 9.25 hrs
• Puberty related change in timing of sleep-wake cycle
– Later sleep time and later wake time

39. Myth
I can do whatever I want before
bedtime and sleep well

40. Data About Television and Sleep
• Preschool children that watch television before bed
have:
– More disrupted sleep
– More nightmares
– More awakenings
– More bedtime resistance
• Can cause behavioral sleep issues in children

41. Sleep Disrupters
•
•
•
•
•
•
•
•
Caffeine
Nicotine
Alcohol
Medications
“Busy bedroom”
Exercising before bed
Eating large meals before bed
Watching television to fall asleep

42. Sleep Promoting Tips
•
•
•
•
•
•
•
•
Consistent bedtime routine
Regular exercise earlier in the day
Avoid a busy bedroom
Avoid bright light at night
Avoid stimulating activities before bed
Avoid the sleep disrupters
Establish good sleep habits even in your children
A cool, dark, quiet bedroom

43. Myths
• Sleep problems are easy to fix with a pill
• There is a magic pill
• Everyone is the same

46. Conclusions
• Sleep is important and worthy of being
nurtured for good health
– Good sleep habits are essential no matter how
old you are
• Sleep can impact many others facets of life
and should not be taken for granted
• Invest in your future – take care of your sleep…