Sleep Issues and CPR Confusion: A Family Medicine Perspective

Q: Sleep Issues and CPR Confusion: A Family Medicine Perspective

Dear Ms. <br>Yu：<br>1. <br>The human sleep cycle can be divided into Rapid Eye Movement (REM) sleep and Non-Rapid Eye Movement (NREM) sleep, which alternate throughout the night, typically cycling 3 to 5 times. <br>The brain regions that control the sleep-wake cycle (circadian rh

Sleep issues and concerns about CPR?

Hello, doctor.
I have two questions regarding issues that have arisen around me.

First, a friend of mine has a work schedule where he usually gets home around 7 PM and doesn't go to bed until 2 or 3 AM.
He then has to wake up at 7 AM to prepare for work.
However, on weekends, he tends to come home at 7 PM, tidies up, and goes to sleep around 8 or 9 PM.
He often wakes up briefly but then continues to sleep until around 3 PM the next day.
This pattern occurs frequently on weekends.
Is this behavior a result of his previous sleep schedule, or could there be an underlying issue? If necessary, which medical specialty should he consult?
Second, regarding CPR, if a person has stopped breathing and has a weak pulse, and a blood pressure monitor indicates a heart rate of around 40 beats per minute, can I still perform CPR? Is it possible for a person to have either a heartbeat or breathing but not both? I apologize for the trouble, and thank you for your assistance.

yu, 20~29 year old female. Ask Date: 2019/04/30

Dr. Xiao Yongxun reply Family Medicine

Dear Ms.
Yu:
1.
The human sleep cycle can be divided into Rapid Eye Movement (REM) sleep and Non-Rapid Eye Movement (NREM) sleep, which alternate throughout the night, typically cycling 3 to 5 times.
The brain regions that control the sleep-wake cycle (circadian rhythm) include the suprachiasmatic nucleus, the preoptic area (which promotes sleep), and the posterior hypothalamus (which inhibits sleep).
The sleep cycle changes with age; specifically, REM sleep occurs approximately every 90 minutes, gradually increasing in duration until waking in the morning.
In infancy, REM sleep accounts for about 50% of total sleep time, while in adults it accounts for about 20%, and even less in the elderly, indicating the lowest neural activity in older adults.
Your friend's questions should be addressed by themselves or by consulting a physician, as many details need to be clarified to better understand their individual sleep patterns.
Factors contributing to such sleep habits may include personal lifestyle choices, the consumption of caffeine, tea, or energy drinks, work-related stress or occupational factors, or potential health issues.
Even if examinations appear normal, there may be other underlying causes.
Please advise your friend to discuss these concerns with their family physician or to seek care at a sleep medicine clinic.
2.
It is common in clinical practice for a patient to have no breathing but still have a heartbeat.
Theoretically, cardiopulmonary resuscitation (CPR) should be performed, primarily focusing on airway management and artificial ventilation.
If there is no heartbeat, there will be no spontaneous breathing, according to clinical reports and theoretical understanding; CPR involves chest compressions and artificial respiration.
This is a general overview, and emergency procedures are updated every four years, with most changes being minor, though sometimes there may be significant adjustments.
If there are further questions, please consult your family physician or a cardiologist or emergency medicine physician at the hospital.

Reply Date: 2019/04/30

More Info

Understanding sleep issues and CPR can be quite complex, and your questions touch on important aspects of both sleep health and emergency response. Let’s break down each concern.

Sleep Patterns and Health Concerns
Your friend’s sleep pattern raises several potential issues. The irregularity in sleep schedules, particularly the drastic difference between weekdays and weekends, can lead to what is often referred to as "social jetlag." This occurs when a person’s internal clock (circadian rhythm) is misaligned with their social obligations, such as work.
1. Sleep Deprivation and Quality: Your friend is getting approximately four to five hours of sleep on weekdays, which is below the recommended seven to nine hours for adults. Chronic sleep deprivation can lead to various health issues, including impaired cognitive function, mood disturbances, and increased risk for chronic conditions such as obesity, diabetes, and cardiovascular disease.

2. Sleep Disorders: The pattern of staying up late and sleeping excessively on weekends could indicate a potential sleep disorder, such as delayed sleep phase disorder or even insomnia. It’s essential for your friend to evaluate whether he experiences difficulty falling asleep, staying asleep, or waking too early.
3. Consultation Recommendations: Given these concerns, it would be advisable for your friend to consult a healthcare professional. A family physician can provide an initial assessment and may refer him to a sleep specialist if necessary. A sleep study (polysomnography) might be recommended to evaluate his sleep architecture and identify any underlying sleep disorders.

CPR and Cardiac Emergencies
Your second question pertains to CPR (cardiopulmonary resuscitation) and the physiological states of heart and breathing.
1. Understanding Heartbeat and Breathing: It is indeed possible for a person to have a weak pulse (bradycardia) while not breathing adequately or at all. In such cases, the heart may still be beating, but the person may not be able to maintain effective circulation due to inadequate heart rate or blood pressure.

2. When to Administer CPR: If a person is unresponsive and not breathing normally, or if they have a weak pulse (like the 40 beats per minute you mentioned), CPR should be initiated immediately. The primary goal of CPR is to maintain blood flow to vital organs until emergency medical services arrive.
3. CPR Techniques: In this scenario, you would perform chest compressions and rescue breaths if trained to do so. The American Heart Association recommends a compression-to-breath ratio of 30:2 for adults. If you are unsure about giving rescue breaths, hands-only CPR (just compressions) is also effective and recommended in many situations.

4. Awareness of Conditions: It’s crucial to recognize that certain medical conditions can lead to a person having a heartbeat without effective breathing. For instance, conditions like severe respiratory distress, certain arrhythmias, or even drug overdoses can present in this manner.

Conclusion
In summary, your friend's sleep issues could stem from lifestyle habits or underlying sleep disorders, and it would be prudent for him to seek medical advice. As for CPR, it is vital to act quickly in emergencies, even if the person has a weak pulse. Understanding these topics can significantly impact health outcomes and emergency responses. Encourage your friend to prioritize sleep hygiene and consult a healthcare provider, and ensure you are prepared to act in emergencies by staying informed about CPR techniques.

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