Cannabinoids and Health
Module 7
Lecture 4: Sleep and Sleep Disorders
Why is sleep important?
• Sleep is involved in healing your heart and blood vessels –
sleep deficits have been linked with heart disease, and
stroke
• Sleep deficits lead to imbalances in hormones that govern
eating and is associated with obesity
• Sleep also affects how the body reacts to insulin and sleep
deficits lead to a higher than normal blood sugar level,
increases risk for Type 2 diabetes
• Sleep keeps the immune system healthy and deficits can
reduce effectiveness of the immune system
Image source: [Link]
What is sleep?
• Sleep is a behavior that follows a circadian rhythm
• Sleep is organized into cycles (e.g., it is not uniform
throughout the night)
• Sleep is defined by four behavioral criteria:
• Reduced motor activity
• Decreased response to activity
• Stereotypic postures
• Reversability
Sleep Stages
• Stage 1 (NREM)
• lightest stage of NREM sleep
• slow eye movements, muscle tone relaxes, brain activity
slows (can be easily awakened)
• Stage 2 (NREM)
• brain waves continue to slow
• decreased body temperature, heart rate slows
• Stages 3 + 4 (NREM)
• deep sleep (delta waves or slow waves)
• REM sleep
• accounts for about 25% of sleep
• in humans it occurs about once every 90 minutes
• high neural activity, rapid eye movements and increased
heart rate, low muscle tone
Sleep Apnea
• Characterized by pauses or gaps in breathing due to
an obstruction of the airway
• Signs and Symptoms
• Loud, regular snoring
• Large neck size
• Obesity
• Associated with major
medical conditions
Insomnia
• A perception or complaint of
inadequate or
poor sleep
• Difficulty falling asleep
• Frequent awakenings
• Waking too early and having
difficulty
falling back to sleep
• Waking unrefreshed
• Next day consequences
Circadian Rhythm Disorders
• Disruption in a person’s natural (“circadian”) clock that
regulates the ~24 hour cycle of biological processes
• Delayed Sleep-Wake Phase: go to sleep late, wake up late, more
common in children and adolescents, 7-10%
• Advanced Sleep-Wake Phase: go to sleep early, wake up early,
increases with age, 1% of middle-aged adults
• Irregular Sleep-Wake Phase: irregular sleep-wake patterns
• Non-24-Hr Sleep-Wake Rhythm: sleep time shifts later each day
• Shift Work Disorder: non-traditional work schedule
• Jet Lag: when traveling long distances
Sleep Deprivation
• In humans, sleep deprivation most negatively
impacts cognitive performance (especially reaction
time)
• The effects of sleep deprivation on driving
performance are similar to the effects of alcohol
• Following sleep deprivation, people spend more
time in REM sleep
• In animal studies, extreme sleep deprivation leads
to illness and even death
Sleep in the General Population
• Poor sleep is very common in the US!
• Data from the 2014 Behavioral Risk Factor Surveillance System
on prevalence of healthy sleep duration (≥7 hours) in 444,306
adults:
• Only 65.2% reported healthy sleep duration!
• Prevalence of healthy sleep lower in non-Hispanic blacks,
American Indians/Alaska Natives, Native Hawaiians/Pacific
Islanders, and multiracial respondents
• State-based estimates of healthy sleep duration ranged from
56.1% in Hawaii to 71.6% in South Dakota.
Liu et al., 2014, CDC, Morbidity and Mortality Weekly Report
Sleep Efficiency (% of time asleep
while in bed): Changes with Age
Changes with age
(% Time in Bed Sleeping)
Sleep Efficiency
Men
Women
Age
Prevalence of Sleep Disorders:
The Veteran Population
From: The National Veteran Sleep Disorder Study: Descriptive Epidemiology and Secular Trends, 2000–2010
Sleep. 2016;39(7):1399-1410. doi:10.5665/sleep.5972
Sleep |
Sleep and Pain
• Sleep complaints are present in 67 to 88% of chronic pain
patients
• Pain contributes to sleep disturbance (i.e., it makes sleep
difficult)
• Sleep problems significantly increase the experience of
pain
• Disturbed sleep may impact processes that contribute to
development and maintenance of chronic pain
• Neuroendocrine mechanisms
• Inflammatory mechanisms?
Finan et al., 2013, The Journal of Pain
Sleep and Anxiety/Depression
• A recent systematic review looked at associations
between sleep, anxiety and depression:
• insomnia and sleep quality were bidirectionally related
to anxiety and depression
• sleep problems predict higher levels of depression and a
combined depression/anxiety variable
• anxiety predicts excessive daytime sleepiness
Pasquale, 2013, Sleep
Sleep and PTSD
• Sleep disturbance (particularly nightmares and
insomnia) is a hallmark feature of PTSD and is also
prevalent in veterans with Traumatic Brain Injury
(TBI)
• Poor sleep has a negative impact on treatment of
and recovery from PTSD and TBI
• Interventions that help with sleep may also help
treatment of PTSD and TBI
Gilbert et al., 2015, Clinical Psychology Review
Summary
• Only 65% of people report healthy sleep duration
• Many factors influence poor sleep (e.g., caffeine,
alcohol, stress, etc)
• Poor sleep has a number of negative effects and is
associated with chronic pain, anxiety and
depression, and PTSD
• Poor sleep worsens pain, PTSD, anxiety and depression
• Chronic pain, anxiety/depression, and PTSD worsens
sleep problems