Sleep=Consequence Q & A
Q: Please elaborate on why seniors sleep less than younger adults and whether it would be better if they slept more.
Dr. Fleming
A: This is controversial. If you take into account normal aged probably do not sleep less than younger people but their sleep becomes biphasic with some sleep occurring during the day as naps. So in 24 hours they may sleep as long as normal younger people but in two or more lots. In patients with insomnia as a prominent complaint there is some evidence that sleep need is less because physiological hyperarousal is higher. The general rule is you should sleep as much (and no more) than that which keeps you alert the next day. As we age sleep is less stable and one way to keep it more solid is to take of 15-30 mins from your usual sleep time as this will help consolidate night time sleep. Then there are other things that are being investigated like light exposure and melatonin – all because the circadian system weakens once we pass about 50 years of age.
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Q: Do you find the long term effects of sleeping pills to be a rebound insomnia effect?
Dr. Fleming
A: It depends on the pill. All sedative-hypnotics cause physiological dependence so when you abruptly stop you get rebound (sleep performance worse than when you went on the pills) for a couple of nights. Some drugs like zopiclone (Imovane and others) are supposed to have less rebound but this is controversial.
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Q: If someone regularly sleeps 3 hours per night and is happy, healthy and without other problems, should she be concerned or be trying to increase her sleep time?
Dr. Weiss
A: There are constitutional short sleepers who need less sleep. However, if someone is forcing themselves to sleep 3 hours when their body wants to sleep longer that is different
Dr. Fleming
No if there is no impairment in functioning – especially daytime sleepiness - she is probably a short sleeper. However, three hours is at the very short end of the usual sleep period
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Q: What is your (any/all panelists) opinion of "herbal" sleeping pills? If a patient finds they do work, is this an example of a placebo working rather than actual pharmaceutical effects? In other words, can one put oneself to sleep as well as put oneself out of sleep?
Dr. Weiss
A: Melatonin is not an herb. It is a human hormone but is has been classified as an alternative medicine. It is quite safe. There are now 3 double blind well done studies showing it works well in ADHD and several others in other disorders.
Dr. Fleming
If a patient finds they do work, is this an example of a placebo working rather than actual pharmaceutical effects? In other words, can one put oneself to sleep as well as put oneself out of sleep? Depends on the herb. Valerian works like a benzodiazepine. The placebo effect in sleep disorders is quite high (40-60%) so it can be a placebo effect. The most important thing is to be sure about what you are taking. In the US 40% of melatonin products contained no melatonin (in one unpublished study) and manufacturers have been known to put antihistamine in herbal sleep products.
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Q: What are the factors that may predispose one to poor or non-restorative sleep?
Dr. Fleming
A: They are multiple as was discussed in the session. Basically anything that causes awakenings can lead to non-restorative sleep but also daytime stress (what you wake into) can lead you to retrospectively evaluate your sleep as insufficient.
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Q: What association, if any, is there between ADHD and OSA in children?
Dr. Fleming
A: OSA can cause ADHD symptoms; ADHD symptoms don’t cause OSA.
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Q: Can napping be used to treat ADHD?
Dr. Weiss & Dr. Fleming
A: No; most kids and adults with ADHD have difficulty napping.
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Q: Do children with ADD experience sleep disorders
Dr. Weiss
A: Yes, definitely as demonstrated now on polysomnograms, actigraphs (a wrist watch measuring movement) and on sleep diaries.
Dr. Fleming
Yes they have increased prevalence of Restless Legs Symptoms, Apnea and sleep interruptions secondary to medications.
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Q: If I dream immediately after falling asleep does that mean I'm depressed?
Dr. Fleming
A: No. Sleep onset “dreams” are usually Stage 1 light sleep phenomena which are usually just images.
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Q: Are people who have lots of REM sleep / less deep sleep more likely to have nonrestorative sleep?
Dr. Fleming
A: If they waken from disturbing dream material, yes.
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Q: Does childhood trauma lead to adult sleep disorders?
Dr. Fleming
A: Commonly yes.
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Q: I am interested in the Web Sites
related to Health 2.0, Social Networks and Sleep Health
mentioned by Dr.
Salzwedel
and Mr. White
A: For Health 2.0, Social Networks and Sleep Health resources click here
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Q: Why are circadian rhythms not on a 24 hour cycle?
Dr. Ipsiroglu
A: Circadian rhythms are endogenously generated, but can be modified by external cues. The primary external cue (Zeitgeber) is daylight which changes throughout the year with the exeption of areas around the equator. Thus circadian rhythms are roughly a 24-hour cycle in the biochemical, physiological or behavioural processes of living beings
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Q: Is there a correlation between sleep deprivation and sleep paralysis?
Dr. Ipsiroglu
A: Sleep deprivation can exacerbate sleep paralysis so getting a good, appropriate amount of sleep is important. Please also see the question re sleep paralysis on Oct. 29th session answered by Drs. Witmans, Steger, Kloesch and Ipsiroglu.
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Q: Would it be better to have (develop) preventative parent training to help parents develop healthy sleep patterns for their babies rather than doctor referrals once sleep disorders develop?
Dr. Ipsiroglu
A: You highlight the issue of knowledge dissemination. Preventive parent training by public health nurses or other health care professionals is one way for this. Another way might be social networks, such as those discussed by Dr. Marc White, and of course the Mini Med School activities which address interested individuals and enable them to demystify research and scientific knowledge, thus helping to develop their own prevention strategies
