Insomnia and poor sleep
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Insomnia and poor sleep Dr Phillippa Lawson Consultant sleep physician East Anglia
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Insomnia and poor sleep. Dr Phillippa Lawson Consultant sleep physician East Anglia. About me. Live in Saffron Walden Consultant in sleep, respiratory and general medicine at West Suffolk Hospital Founder of the good sleep programme Mother to two professors!. Outline. What is it? - PowerPoint PPT Presentation
Transcript of Insomnia and poor sleep
Insomnia and poor sleep
Dr Phillippa LawsonConsultant sleep physician
East Anglia
About me• Live in Saffron Walden• Consultant in sleep, respiratory and general
medicine at West Suffolk Hospital• Founder of the good sleep programme• Mother to two professors!
Outline• What is it?• Who does it affect?• How is it diagnosed?• What can be done?
What is insomnia?• Difficulty falling asleep• Difficulty staying asleep• Early morning wakening• Non-refreshing or non-restorative sleep
plus• Daytime symptoms• Prolonged
Who does it affect?• Anyone!• Prevalence 10 – 48 % depending on study methods• UK study§ found incidence to be 15 %, prevalence 37%• More common in females (55 %)• Median age 50 years (18 – 98)• Persistence of insomnia associated with increasing age• Associated with mental health problems• Associated with physical health problems• Associated with other sleep disorders
§Morphy et al SLEEP 30 (3) 2007
What causes insomnia?
Predisposing factors• Genetics• Hyperarousal• Depression• Tendency to worry and ruminate
Precipitating factors• Acute stress• Illness (physical or mental)• Medications• Worry and rumination
Perpetuating factors• Dysfunctional attitudes about sleep• Staying awake in bed• Increased time in bed• Worry and rumination about
insomnia
How do we diagnose it?
• Who? Self-diagnoseGPSpecialist in sleep medicine
• How? ‘Sleep history’QuestionnairesSleep diaryActigraphyPolysomnogram
Sleep diary example
How do we diagnose it?
• Who? Self-diagnoseGPSpecialist in sleep medicine
• How? ‘Sleep history’QuestionnairesSleep diaryActigraphyPolysomnogram
What can be done?Set your goalsGeneral wellbeing
• Nutrition and fluid intake• Alcohol intake• Caffeine intake• Nicotine• Exercise• Sun light• Incorporating rest times• Positive attitude
What can be done?Preparing the sleep environment
• Temperature• Bed and bedding• Light• Calm, uncluttered environment• Clocks and technology!
‘Sleep hygiene’• Regular bed/rise times• Avoiding napping• ‘Wind down’ routine
What can be done?Stimulus control
• Get out of bed when can’t sleep• Stop all sleep-incompatible activities• Strengthen the bed-sleep association
Sleep restriction• Reduce time in bed to actual sleep time• Shorten time in bed• Improves sleep efficiency and strengthens bed-sleep
association• Avoids disrupted and fragmented sleep
Sleep efficiencyTotal sleep time
(time from falling asleep to time you woke for final time minus estimated time spent awake during night)
÷Total time in bed
(time from lights out to time you finally got up)
X 100
Sleep diary example
What can be done?Stimulus control
• Get out of bed when can’t sleep• Stop all sleep-incompatible activities• Strengthen the bed-sleep association
Sleep restriction• Reduce time in bed to actual sleep time• Improves sleep efficiency and strengthens bed-sleep
association• Avoids disrupted and fragmented sleep
What can be done?Relaxation
• Progressive muscle relaxation/yoga/Alexander technique• Breathing exercises• Mindfulness• Imagery
Cognitive techniques• Thought blocking• Listing the positives• Turning the tables• Trying to stay awake• Alternative thinking techniques• Carefree attitude towards sleep• Test the hypothesis• Consider cognitive behavioural therapy and related techniques
Alternative thinking example
A carefree attitude towards sleep!
What can be done?Relaxation
• Progressive muscle relaxation/yoga/Alexander technique• Breathing exercises• Mindfulness• Imagery
Cognitive techniques• Thought blocking• Listing the positives• Turning the tables• Trying to stay awake• Alternative thinking techniques• Carefree attitude towards sleep• Test the hypothesis• Consider cognitive behavioural therapy and related techniques
But what about medication?
• Many on the market• Frequently employed• Intended as short term aid but often become long
term crutch• Daytime side effects• Treating a symptom, not the cause• Perhaps more useful as an ad hoc adjunct, for
acute problems
Conclusion• Insomnia is not a life sentence• Seeking help is the first step towards moving
forward• The ability to succeed comes from within but
gaining support will increase your chances of doing so
• Positive thinking is key• Believe!
"If you think you'll lose, you're lost,For out in the world we find
Success begins with a fellow's will;It's all in the state of mind.
Life's battles don't always goTo the strongest or fastest man;
But soon or late the man who winsIs the man who thinks he can."
Walter D. Wintle
thegoodsleepprogrammetake charge, move forward, live life
