Sleep and Health

Cover
Sleep And Health
Copyright
Dedication
Contributors
Preface
Acknowledgments
Part I: General concepts in sleep health
1
The basics of sleep physiology and behavior
	Introduction
		The definition of sleep
		Conceptualizing sleep as a health behavior
		Conceptualizing sleep as a physiological process
			Wakefulness
			NREM sleep: General overview
			NREM: Stage dissection
			Description of REM sleep
			Moving through the sleep stages
		Sleep and circadian rhythms
		Basic sleep physiology
			The brainstem
			The hypothalamus
			The thalamus
			Cerebrum
			Neuromodulators
			The autonomic nervous system
		Quantifying sleep
			Subjective measures
			Objective measures
	Conclusion
	References
2
Epidemiology of insufficient sleep and poor sleep quality
	Sleep at the population level
	Defining insufficient sleep
	Prevalence of insufficient sleep
		Insufficient sleep in the population
		Insufficient sleep by age
		Insufficient sleep by sex
		Insufficient sleep by race/ethnicity
		Insufficient sleep by socioeconomic status
		Insufficient sleep by geography
	Key limitations to population estimates of insufficient sleep
	Prevalence of poor sleep quality
		Prevalence of sleep disorders
		Prevalence of sleep complaints
	Summary and conclusions
	References
3
Sex differences in sleep health
	Introduction
	Sex differences in infant sleep
	Sex differences in childhood sleep
	Sex differences in adolescent sleep
	Sex differences in young adult sleep
	Sex differences in middle-aged sleep
	Sex differences in older adult sleep
	Conclusion
	References
4
Sleep and health in older adults
	Introduction
	Sleep changes in normal aging
		Changes in sleep parameters
		Changes in circadian rhythm
		Changes in sleep homeostasis
	Common sleep disturbances in older adults
		Insomnia
		Sleep-disordered breathing
	Factors associated with sleep disturbances in older adults
	Sleep and health in older adults
		Cognitive function
			Sleep duration
			Self-reported sleep complaints
			Objectively measured sleep disturbances
			Daytime napping
			Excessive daytime sleepiness
			Insomnia
			Sleep disordered breathing
		Cardiovascular health
			Sleep duration
			Sleep disordered breathing
			Insomnia and other sleep disturbances
		Psychiatric illness
			Sleep duration
			Insomnia
			Sleep-disordered breathing
			Sleep quality and other sleep disturbances
		Pain
	Conclusion
	References
5
Social-ecological model of sleep health
	Introduction
	The social ecological model
	Sleep as a domain of health behavior
	Conceptualizing sleep in a social-ecological model
	Individual level
	Social level
	Societal level
	Combining upstream influences and downstream consequences
	Applications of the model
	References
Part II: Contextual factors related to sleep
6
Race, socioeconomic position and sleep
	Introduction
	Brief) history and definition of health disparities
	Sleep characteristics
		Self-reported sleep duration across racial/ethnic groups
		Objective reported sleep duration across racial/ethnic groups
		Sleep duration within racial/ethnic groups
		Sleep duration across SES groups
		Sleep architecture and continuity across racial/ethnic groups
		Sleep architecture and continuity across SES groups
	Sleep disorders
		Sleep disordered breathing (SDB)
		Symptoms of and risk factors for sleep disordered breathing across racial/ethnic groups
		Diagnosis of SDB across and within racial/ethnic groups
		SDB symptoms and diagnosis across SES groups
		Insomnia
		Insomnia complaints across racial/ethnic groups
		Insomnia complaints across SES groups
		Restless leg syndrome (RLS) and periodic limb movements during sleep (PLMS)
		Narcolepsy
		Circadian rhythms
	Why do minority Americans have poor sleep?
		Acculturation
		Perceived discrimination
		Worry and risk perception
		Sleep opportunity
	Future directions and summary
	References
7
Neighborhood factors associated with sleep health
	Neighborhoods and sleep health
	Theoretical justification for neighborhoods and sleep health
	Neighborhood factors associated with pediatric sleep
		Urbanicity and population density
		Neighborhood socioeconomic status (NSES)
		Neighborhood access to physical activity
		Neighborhood violence and safety concerns
	Neighborhood factors associated with adult sleep
		Inadequate sleep duration and delayed sleep timing
		Insomnia
		Obstructive sleep apnea (OSA)
	Current limitations and future directions
		Studying long-term trajectories of neighborhood conditions and sleep
		Evaluating evidence from natural experiments and other causal methods
		Using technological advances to studying neighborhoods and sleep at a larger scale
	Are there interventions and policies to improve neighborhoods and sleep health?
	Conclusions and public health significance
	Acknowledgments
	References
8
The impact of environmental exposures on sleep
	The physical environment and sleep
		The impact of light on sleep
		The impact of temperature on sleep
		The impact of noise on sleep
		The impact of vibrations on sleep
		The impact of air quality on sleep
		The impact of seasonality and latitude/longitude on sleep
	The social environment and sleep
		Psychosocial stress and sleep
		Social conditions, policies, institutions: The impact of socioeconomic status and racism on sleep
		Community: The impact of neighborhood social and physical environments on sleep
		Community: Work environment and sleep
		Interpersonal relationships and sleep
		Acknowledgments
	References
	Glossary
Part III: Addressing sleep health at the community and population level
9
Obstacles to overcome when improving sleep health at a societal level
	Introduction
	Real-world barriers to sleep health
		Lack of time
		Social norms and beliefs
		Physical environment
		Health conditions and chronic pain
		Substance use
		Distractions and on-demand culture
	Conceptualizing strategies for overcoming these barriers
		The health belief model and application to sleep
		The integrated behavioral model and application to sleep
		The transtheoretical stages-of-change model
		Other health behavior models
	Implementing sleep health programs
		Addressing perceived benefits
		Addressing perceived barriers
		Addressing social norms
		Addressing self-efficacy and control
		Addressing readiness
	Conclusion
	References
10
Screening for sleep disorders
	Introduction
	Sleep-disordered breathing
		STOP-BANG questionnaire
		Berlin questionnaire
	Hypersomnolence
		Epworth Sleepiness Scale (ESS)
		Functional Outcomes of Sleep Questionnaire (FOSQ-30)
		Stanford Sleepiness Scale (SSS)
		Karolinska Sleepiness Scale (KSS)
	Insomnia and sleep quality
		Insomnia Severity Index (ISI)
		Pittsburgh Sleep Quality Index (PSQI)
		Patient-Reported Outcomes Measurement Information System (PROMIS™)
	Circadian rhythm disorders
		Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ)
		Munich Chronotype Questionnaire (MCTQ)
	Restless legs syndrome (RLS)
		International Restless Legs Syndrome Scale (IRLS)
	Consumer sleep technologies
		Fitbit
		Jawbone
		SleepScore Max and SleepScore app
		Other novel technologies
	Using screening data
	References
11
Sleep hygiene and the prevention of chronic insomnia
	Sleep hygiene
		What is sleep hygiene?
		Exercise
		Caffeine
		Alcohol
		Food and liquid intake
		Nicotine
		Bedroom environment
		Removal of electronics
		Clockwatching
		Measuring sleep hygiene
		Do people with insomnia have poorer sleep hygiene than normal sleepers?
		What is the role of sleep hygiene in the management of insomnia?
		So, is there a role for sleep hygiene in sleep medicine and practice, beyond insomnia?
	The prevention of chronic insomnia
		Etiological models of insomnia
		What we know about acute insomnia?
		Can we prevent acute insomnia from becoming chronic?
		Identifying those at risk
	Conclusions
	Conflict of Interest
	References
12
Actigraphic sleep tracking and wearables: Historical context, scientific applications and guidelines, limitations, and cons ...
	Introduction
	Scoring algorithms
	Types of actigraph devices
	Limitations of actigraphy and related considerations
	Identifying sleep stages with actigraphy
	Other considerations
	Scientific guidelines
	Evaluating commercially-available sleep trackers
	Conclusions
	References
13
Mobile technology, sleep, and circadian disruption
	Sleep as a biobehavioral state
		Two-process model of sleep physiology
		Contextual factors influencing sleep behavior and mobile technology use
		Importance of sleep for health
		Sleep loss impacts physical and psychological health and wellbeing
			Sleep loss and sleep deficiency
				Sleep deprivation
				Sleep restriction
				Sleep fragmentation
				Circadian dysfunction
				Sleep disorder
		Negative consequences for individuals and public health concern
			Chronic disease
			Cognitive function
	The role of mobile technology in sleep loss
		Emergence of mobile technology
		Impact of sleep loss
			Time displacement
				Sleep deprivation
				Sleep restriction
				Sleep fragmentation
			Exposure to artificial light
				Circadian disruption
			Psychological stimulation and stress by media content
			Mobile technology use as an epiphenomenon of insomnia
	Conclusions
	References
14
Models and theories of behavior change relevant to sleep health
	Foundation of theory for behavior change
	Utility of theory for changing health behaviors
	Causation in behavior change theories
	Types of theories
	Intrapersonal theories
		Health belief model
			Continuum theory
			Application
		Theory of reasoned action and the theory of planned behavior (continuum theory)
			Theory of reasoned action
			Theory of planned behavior
			Application
			The model of goal-directed behavior
			Application
		The transtheoretical model
			Stage theory
			Application
	Interpersonal theories
		Social cognitive theory
			Continuum theory
			Application
		Social network theory
			Continuum theory
			Application
	Community level theories
		Diffusion theory
			Stage theory
			Application
		Behavioral economics
			Continuum theory
			Application
	Measurement of models and theories for behavior change interventions
		Step 1: Define purpose of instrument
		Step 2: Identify objects of interest
		Step 3: Constitutively define objects of interest
		Step 4: Operationally define objects of interest
		Step 5: Review previously developed instruments
		Step 6: Develop an original instrument
		Step 7: Select appropriate scales
		Step 8: Develop items
		Step 9: Prepare a draft instrument
		Step 10: Test for readability
		Step 11: Send to panel of experts
		Step 12: Conduct a pilot test
		Step 13: Establish reliability and validity
	Limitations of behavior change theories
	Conclusion
	References
Part IV: Sleep duration and cardiometabolic disease risk
15
Insufficient sleep and obesity
	Sleep duration
		Obesogenic behaviors
		Potential physiological mechanisms
		Group differences
		Individual differences
	Sleep timing
	Sleep disorders
	Sleep in individuals with obesity
	The role of sleep in weight loss interventions
	Conclusion
	References
16
Insufficient sleep and cardiovascular disease risk
	Introduction
		Defining insufficient sleep
	Pathophysiology
		Insufficient sleep and blood pressure
		Insufficient sleep and coronary heart disease
		Insufficient sleep and heart failure
		Insufficient sleep and stroke
	Conclusions
	References
17
Sleep health and diabetes: The role of sleep duration, subjective sleep, sleep disorders, and circadian rhythms on diabetes
	Sleep parameters and diabetes risk
		Sleep duration and diabetes
			Insufficient/short sleep duration's influence on type 2 diabetes, insulin resistance, and obesity: Mechanisms
				Indirect relationship between insufficient/short sleep and diabetes
			Long sleep duration's influence on type 2 diabetes, insulin resistance, and obesity
			Protective effects of longer sleep and diabetes
			Negative associations between long sleep on diabetes
				Indirect relationship between long sleep and diabetes
			Summary
		Qualitative sleep parameters (sleep quality, excessive daytime sleepiness and social jet lag) and diabetes
			Sleep quality
			Excessive daytime sleepiness and social jetlag
			Physiological and biological mechanisms
				Insulin resistance
				Leptin and ghrelin hormones
				Inflammation
		Sleep disorders and diabetes
			Obstructive sleep apnea
			Insomnia
			Epidemiological and population level studies
			Mechanistic studies
		Circadian rhythm and diabetes
			Independent and interactive associations between endogenous circadian rhythm and diabetes
			Exogenous
			Endogenous and exogenous
			Circadian misalignment and diabetes
		Indirect effects of sleep on diabetes
			Obesity moderates or mediates the relationship between sleep and diabetes
			Visceral adiposity and not obesity is responsible for the relationship between sleep disturbances and diabetes
		The exacerbating role of sleep on well-being, quality of life, health and mortality among diabetics
		Healthy sleep and reduced diabetes risk
	References
18
Social jetlag, circadian disruption, and cardiometabolic disease risk
	Introduction
	Definitions and epidemiology
		Cardiometabolic syndrome
		Circadian rhythms
		Circadian disruption and social jetlag
		Circadian disruption and cardiometabolic health
	Circadian control of the cardiometabolic system
		Cardiovascular functioning
		Metabolism
			Glucose metabolism
			Lipid metabolism
			Energy metabolism
	Environmental rhythms and cardiometabolic health
	Behavioral rhythms and cardiometabolic health
	Biological rhythms and cardiometabolic health
		Autonomic nervous system
		Metabolically relevant hormones
			Insulin
			Glucagon-like peptide 1 (GLP-1)
			Cortisol
			Melatonin
			Growth hormone
			Ghrelin and leptin
			Bi-directional regulation
	Conclusion and future directions
	References
Part V: Sleep and behavioral health
19
Sleep and food intake
	Introduction
	Part 1: Sleep loss and food intake
	Part 2: Proposed mechanisms explaining the sleep-food intake relation
		Homeostatic mechanisms
		Nonhomeostatic mechanisms
	Part 3: Influence of food intake on sleep duration and quality
		Caloric consumption
		Protein
		Carbohydrates
		Fat
		Vitamins and supplements
			Melatonin
			B vitamins
			Isoflavones
			Magnesium
		Fruits
		Alternative medicine
			Valerian
			Kava
		Total dietary approaches
	Conclusion
	References
20
Sleep and exercise
	Impact of exercise on sleep
		Observational research
		Experimental research
			Acute exercise
			Chronic exercise training
		Sedentary behavior
		Potential mechanisms of exercise
			Anxiolytic and antidepressant effects
			Circadian phase-shifting effects
			Body temperature effects
			Adenosine
	Impact of exercise on sleep disorders
		Insomnia
		Sleep-disordered breathing
		Restless legs syndrome/periodic limb movements during sleep
	A bidirectional relationship: Impact of sleep on exercise
	Combined impact of exercise and sleep on health
	Conclusion
	References
21
Sleep and alcohol use
	Introduction
	Neurobiology of alcohol use
	Insomnia and alcohol use
		Clinical findings
		Insomnia in alcohol dependence
		Treatments
	Circadian rhythms and alcohol use
		Clinical findings in shiftwork and alcohol use
		Chronopharmacokinetic studies
		Alcohol dependent individuals
	Alcohol and sleep duration abnormalities
	Breathing related sleep disorders and alcohol use
		Summary
	Alcohol and sleep-related movement disorders
	Parasomnias and alcohol use
	Other sleep-related issues associated with alcohol use
	Discussion
	References
	Further reading
22
Improved sleep as an adjunctive treatment for smoking cessation
	Introduction
	Epidemiology of cigarette smoking
	Sleep continuity and architecture in smokers versus non-smokers
		Overview of sleep continuity and architecture
		Sleep architecture in smokers versus non-smokers
		Sleep continuity in smokers versus non-smokers
		Sleep fragmentation in smokers versus non-smokers
		Daytime sleepiness in smokers versus non-smokers
		Summary
	Smoking abstinence and sleep
		Changes in sleep following abstinence
		Relationship between sleep and cessation outcome
		Effects of pharmacotherapy on sleep
			Nicotine replacement therapy
			Bupropion
			Varenicline
		Take home points: Relationship between sleep and cessation outcome
	Possible mechanisms linking poor sleep to smoking cessation outcomes
	Plausible adjunctive sleep therapies to promote smoking cessation
		Overview
		Behavioral treatments
		Pharmacological treatments
	Directions for future research
	Acknowledgments
	Conflicts of Interest
	References
23
Sleep and the impact of caffeine, supplements, and other stimulants
	Introduction
	Epidemiology
		Epidemiology of sleep in caffeine
		Epidemiology of sleep in energy drink supplements
		Epidemiology of sleep in other psychostimulants
		Relationships in specific populations
	Physiology of caffeine in sleep-wake homeostasis
		Role of adenosine and caffeine in sleep-wake cycle
		Genetic factors and response to caffeine
		Environmental factors and response to caffeine
	Health implications of caffeine(stimulant) use—sleep disturbances model
	Recommendations
	Conclusion
	References
24
Sleep, stress, and immunity
	Introduction
	Overview of the immune system
		Acquired immune system
		Innate immune system
		The aging immune system
	Sleep, acquired immunity, and infectious disease risk
	Sleep, innate immunity, and inflammatory disease risk
	Sleep and immunological aging
	Beyond sleep: Does stress influence immunity?
	Sleep and psychological stress: Reciprocal processes
	How does poor sleep and psychological stress affect immunity?
	Stress-sleep connection and immunity
	Conclusion
	References
Part VI: Sleep loss and neurocognitive function
25
Sleep loss and impaired vigilant attention
	Neurobehavioral consequences of acute and chronic sleep loss
	Differential vulnerability to sleep loss
	Effects of sleep loss on vigilant attention
	The psychomotor vigilance test (PVT)
	PVT software and hardware
	PVT duration
	PVT outcome metric
	Research agenda
	References
26
Sleep loss, executive function, and decision-making
	Introduction
	Neurobiology of sleep and fatigue
	Alertness, sustained attention, and vigilance
		Psychomotor vigilance
		Wake state instability
	Individual differences
	Executive functions
		Working memory
		Inhibitory control
		Cognitive control
			Multi-tasking and task-switching
			Cognitive interference
			Flexible attentional control
		Problem solving
			Convergent thinking and logical deduction
			Divergent and innovative thinking
	Risk-taking, judgment, and decision-making
		Self-rated risk propensity
		Risky decision-making
			Cognitive framing
			Altered expectations of reward
			Reward-based learning
			Impulsive behavior
			Aggressive/punitive responses
			Moral judgment
	Practical implications
	Conclusions
	References
27
Sleep and healthy decision making
	Introduction
	Sleep as a health behavior
		Influences on sleep and health behaviors
		Short sleep duration is highly prevalent in the population
		What predicts the decision to sleep or not to sleep?
		Some individuals make time to sleep but cannot sleep
	Proposed pathways linking sleep to other health behaviors
		Exposure
		Neurocognitive factors
		Linking sleep related changes in neurocognitive function to health behaviors
		Neuroimaging data
	Affective response to sleep loss
	Effort and motivation
	Does changing sleep make it easier to make healthy decisions?
	Summary
	References
	Glossary
Part VII: Public health implications of sleep disorders
28
Insomnia and psychiatric disorders
	Introduction
	Definition, incidence, and prevalence
		Definition
		Incidence and prevalence
	Theoretical perspectives on the etiology of insomnia
		Stimulus control model
		Behavioral model (Spielman’s 3P model)
		Neurocognitive model
		Cognitive model
		Psychobiological inhibition model
		Parallel process (trans-theoretical) model
	Insomnia and psychiatric morbidity
		Depressive disorders
		Suicide
		Bipolar disorder (BPD)
		Anxiety disorders
		Post-traumatic stress disorder (PTSD)
		Attention-deficit/hyperactivity disorder (ADHD)
		Alcohol use disorder (AUD)
		Autism spectrum disorder (ASD)
		Schizophrenia
	Behavioral treatment of insomnia
		What is CBT-I?
		CBT-I in the context of psychiatric disorders
	Conclusion
	References
29
Insomnia and cardiometabolic disease risk
	Introduction
	Insomnia: A symptom and a chronic disorder
	Hypertension and blood pressure
	Type 2 diabetes and insulin resistance
	Heart disease and stroke
	Stress, immunity and health behaviors
	Public health and clinical implications
	Conclusion
	References
	Glossary
30
Sleep apnea and cardiometabolic disease risk
	What is OSA?
	Who gets OSA?
	Does having OSA make you more likely to have cardiovascular disease?
		Hypertension
		Coronary artery disease
		Cerebrovascular disease
		Heart failure
		Arrhythmias
	Why does OSA make you more likely to have cardiovascular disease?
	What happens if we reduce apneic events?
	Conclusion
	References
Part VIII: Sleep health in children and adolescents
31
Sleep, obesity and cardiometabolic disease in children and adolescents
	Introduction
	Defining overweight and obesity in children
	Causes and consequences of childhood obesity
		Causes
		Consequences
	Attempts to reduce the obesity epidemic
	The importance of sleep in relation to health
	Evidence for a link between sleep duration and obesity in pediatric populations
	Other sleep parameters and childhood obesity
	Sleep and energy homeostasis
	Future directions
	Metabolic disease
	Mechanisms of diabetes
	Sleep and type 2 diabetes mellitus
	Sleep and children
	Sleep, diabetes and children
	Conclusion
	References
32
Sleep and mental health in children and adolescents
	Introduction
	Sleep duration and mental health
	Sleep quality and mental health
	Improving sleep and mental health in children and adolescents
		Families
		Schools
		Clinicians
		Policy makers
	Conclusion
		Summary
		Limitations and future research directions
		Concluding remarks
	References
33
Delayed school start times and adolescent health
	Delaying high school start time improves sleep
	Academic achievement, attention, and truancy
	Mental health and risky behavior
	Unintentional injury
	Conclusions
	References
Part IX: Economic and public policy implications of sleep health
34
Sleep health and the workplace
	Introduction
		Work factors impacts nighttime sleep
		Sleep impacts work function and productivity
		What theories of work can tell us about modifiable work factors influencing sleep
	Epidemiology of sleep and work
		The relationship between sleep and work: Results from a meta-analysis (2017)
	Theories of work and work stress that influence sleep
		Work stress
		Work demands and work-family conflict influence sleep
		Micro-longitudinal (daily level) effects of work stressors on sleep
		Sleep health and workers’ future health risks
	Workplace intervention effects on sleep
		Business case for sleep: Considering the evidence from the employer point of view
		Worksite wellness, and the need for more attention to sleep
		Worksite programs targeting sleep and sleep related outcomes
	Racial ethnic disparities in sleep health and sleep disorders
	Future research topics and directions
	References
	Further reading
35
Sleep health equity
	Introduction: Sleep and public health
	What is sleep health?
	Social determinants of sleep health dimensions and associated health outcomes
	Health differences and the historical sleep gap between blacks and whites
		Identifying determinants of health differences
		History behind the black–white “sleep gap”
		Sleep health as a contributor to health disparities in modern days
	From sleep health disparities toward sleep health equity
	Conclusion
	References
36
Obstructive sleep apnea in commercial motor vehicle operators
	Prevalence
	History of federally-funded research and regulatory activity
	Screening
	Initial evaluation
	Diagnosis
	Treatment
	Monitoring PAP therapy
	Benefits of PAP therapy
	Education
	Conclusion
	References
37
Sleep health as an issue of public safety
	Introduction
	Demographics
		Organizational structure
		Individuals
	Work hours and scheduling characteristics
		Shift duration
		Weekly work hours
		The association between work schedules and health and safety outcomes
		Implementation of schedules based on sleep and circadian principles
	Physiological determinants of alertness
		Physiological determinants of fatigue in public safety
		Sleep deficiency and health
	Sleep disorders
	Fatigue risk management
	Conclusion
	References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	Y
	Z
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