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Running head: RISK REDUCTION ASSOCIATED TO SLEEP PATTERNS 1

Risk Reduction Associated to Sleep Patterns

Whitney Ayers

Ferris State University

RISK REDUCTION ASSOCIATED TO SLEEP PATTERNS 2

Risk Reduction Associated to Sleep Patterns

Everyday people make choices that affect their bodies in either positive or negative ways.

There are many things that can be done in order to protect ourselves from causing additional

harm to our bodies. Some people take measures to be as healthy as possible, usually with a

healthy diet and the proper amount of exercise the body needs to stay healthy. There are many

factors that contribute to being, and staying healthy, for example getting enough sleep, and

abstaining from behaviors that cause the body harm like smoking and alcohol use. There are

other people that put their selves in harm’s way by choosing behaviors that affect the body in a

negative way. These additional stressors can cause the bodies aging process to fast forward and

age faster than they actually are. Drinking, smoking, illegal drug use, unusual amounts of stress,

sleep disturbances, and sedentary lifestyles are just a few of the factors that can cause the body’s

functions to slow down and the” wearing out” process to speed up (Maville & Huerta, 2013).

The real age website is an online resource people can use to find out what their “real age”

is based on their daily choices. After taking the test on the website it will calculate an age based

on the question answered (Oz & Roizen, 2013). The age given may be higher that the persons

actual age if the amount of stressors in a person’s life are in excess, or it could be lower than

their actual age if they make healthy lifestyle choices and are relatively healthy. After the test is

taken the website will give results in all the areas that the test focused on. These are things like

how much sleep a person gets, how much they drink, drug use, stress, financial stability, and

lifestyle habits like diet and exercise. The website gives pointers on how to make better choices

and tips on how to become a healthier person and reduce the risk of disease and chronic illness.


Results

J.L., the partner that I chose to evaluate is also my roommate, which is beneficial to this

assignment because I got the opportunity to see and assess her on a daily basis, and know if the

information she gave on the test is accurate. After taking the RealAge test her real age came

back as nineteen, and her actual age is twenty-three, shown in Appendix A. The results were

surprising because I live with her and know that she has a great number of stressors in her life. I

know that she goes to school full time all year round which is a stressor in its self. She also

works full time on the weekends in order to keep up with her financial demands. She is also in a

long distance relationship which can put additional stress on an individual by not having the

constant support needed to get through daily difficulties. The area that I chose to focus on is her

sleeping habits (Oz & Roizen, 2013).

Although there were many areas in her lifestyle that needed improvement, there were also

areas that she scored well in. The results showed that she takes steps in prevention of illness and

disease such as avoiding sunburns and avoiding second-hand smoke. She does not use drugs and

limits her consumption of alcohol. Although she has a great deal of stress in her life, she finds

proper ways of managing that stress, which is extremely important when assessing one’s health.

J.L. has a lot of support at home which helps her to manage her stress. Having friends and the

support of a family can help to reduce the burden of stress and help to remain healthy. These

areas had a factor in reducing her age one the RealAge test (Oz & Roizen, 2013).

I know from living with her and observing her sleeping patterns that she does not get the

proper about of sleep to meet the body’s need to stay healthy. We have lived together for three

years so I know this pattern has been going on for and extended amount of time, causing the

body additional stress on top of all the other stressors in her life. Her sleeping patterns are not


consistent and she will go numerous nights in a row with very little sleep until her body can’t

take it any longer and she will sleep for ten to twelve hours at a time. She rarely wakes up

feeling completely rested and often complains of feeling tired. On top of all the other issues, J.L.

works nights on the weekends, making it difficult to keep a consistent sleep pattern. A sleep log

shown in Appendix B shows her regular weekly sleep schedule (Oz & Roizen, 2013).

Research

In an article written about the sleep differences in nurses working the day shift versus the

night shift it was found that on average night shirt workers receive an average of one to four hour

decrease in the number of hours spent sleeping each night. It was shown that night shift workers

tend to also have a lower quality of sleep than that of day shift workers. Part of this is because

night shift workers sleep during the day when the body temperature is elevated and cortisol

levels are higher. Cortisol is involved with the sympathetic nervous system and elevated levels

help to produce the “fight or flight” response (Niu et al., 2012). So it makes sense that insomnia

can result from trying to sleep when these levels are at their peak in the body. The research in

this article shows that night shift workers who sleep during the day have less non-rapid eye

movement sleep causing them to sleep fewer hours which in turn causes them to have chronic

fatigue (Niu et al., 2012).

J.L. attends school during the week, and sleeps at night, and works nights at a hospital on

the weekend, and sleeps during the day. This just adds to her problem of feeling fatigue most of

the time. The amount and quality of sleep that is achieved each night can have a significant

impact of the quality of work performance. In J.L.’s case this could have an impact with both her

schooling and her job performance. The researchers argue that a full sixteen hours is needed in

between shift in order to fully recover. This would ensure that workers had time for a full seven


hours of sleep to recover and reduce feelings of fatigue (Niu et al., 2012). Sleep deprivation has

been linked to impaired judgment, lower productivity, and an increased likelihood of accidents.

It has also been linked to job dissatisfaction and higher rates of depression because people feel

they have little control over their work. People who are chronically fatigue also have higher

incidences of illness. This article compares sleep deprived individuals with those that are drunk,

saying that it causes similar side effects. These include poor judgment and decision making,

irritability, and dislocation between the emotional and rational part of the brain. When people

are sleep deprived they are more likely to make critical decisions based on an emotional reaction

instead of using their rational judgment. Depending on the given situation, these judgments can

cause fatalities. The research in this article suggests that people who are sleep deprived and

exhausted tend to eat more, exercise less, and are more prone to depression. Just these side

effects alone can cause many problems when it comes to someone’s condition of health.

Sleeplessness can affect every aspect of the human body, all the way down to the molecular

level. The impact that sleeplessness can have on one’s body can cause a wide range of other

physical and mental health disorders. These disorders included obesity, psychiatric problems,

mood disorders, high blood pressure and are associated with a poorer quality of life compared to

someone who gets adequate sleep (Massey, 2012). Although this article was aimed more

toward the sleeping habits of workers, and J.L. is only a part time worker and a full time student,

there are many similarities between the two.

Wellness Diagnosis

The first wellness diagnosis I have chosen to discuss in relation to J.L. is readiness for

enhanced sleep (Sparks & Taylor, 2010). In order for J.L. to start resolving the health issues

related to her sleeping habits it is important to note her readiness to learn and change. She needs


to know the negative affect that sleep deprivation is having on her body and what the expected

outcome will be if she is to improve her sleeping habits. It may be difficult for her to do this

with her schedule the way it is, working nights on the weekends, and going to school in the day

during the week. Getting into a routine and making sure that an adequate number of hours are

asleep each night will help with her feelings of fatigue. There are many things that can be done

in order to help J.L. achieve this. Even small things like showering before bed or having a cup of

decaffeinated hot tea can help her to relax before bed time. There are also things that can be

avoided immediately prior to sleep like caffeinated beverages and cardio type exercises. One

positive aspect in her sleeping habits is the J.L. rarely needs to take medication in order to fall

asleep or stay asleep. J.L. could help to better her sleep deprivation by setting up a specific

schedule and trying to stick to it. Ensuring that she is getting adequate sleep will ensure that she

wakes rested and is free from fatigue (Sparks & Taylor, 2010).

The other wellness diagnosis I have chosen to talk about is readiness for advanced self-

care. I think this one is even more important for J.L. because there are many other lifestyle

factors that can result in sleep deprivation. Stress is a major factor in why many people don’t get

enough sleep. J.L. has a great deal of stress in her life between going to school, working, and

paying bills. She doesn’t eat properly, with very few fruits and vegetables in her daily diet; she

also does not get the appropriate amount of exercise (Sparks & Taylor, 2010). I think it is

important to focus on these areas because they could be the contributing factor in her sleep

deprivation. J.L. can do this by trying to incorporate some healthier foods into her diet and

making better choices when it comes to food. Adding in fruits and fresh vegetables would give

her more energy that fatty, processed foods. Also making time for exercise every day or even

three or four times a week would help to reduce stress and give her energy. Even things as


simple as going for a walk could help her clear her mind and manage some of the stressors in her

life.

Planning/Intervention

I believe that J.L. is ready for changed based on the behaviors I have observed over the

past few weeks. She knows that her sleeping patterns are unhealthy and could be the underlying

causes of some of her other health complaints. One major stressor she has, other than sleeping

habits is the amount of stress in her life. One goal that I have set for J.L. would be to take time

out of every day to do something that relaxes her. One of my suggestions for her was guided

imagery. Stress can have negative effects on one’s overall physical, mental, and spiritual health.

The perception of stress in the mind can cause negative biological changes in the body and can

lead to physical reactions that can have detrimental effects. Bringing in the mind, body, spirit,

and environment of an individual is a more holistic approach to J.L.’s health than just simply

turning straight to pharmaceuticals. Guided imagery promotes balance, harmony and healing

that I think J.L. would benefit from. Guided imagery is a dynamic, psychophysiological

intervention in which an individual experiences an internal reality in the absence of external

stimuli. It brings power to the mind and body and promotes health and healing. It is a mental

process that involves all the senses to create a perception of stimuli by sending messages from

the brain to the central nervous system. When a mental image is experienced, there is an

emotion, linking the mind with the body. This process mediates communication between

perception, emotion, and physiological change. This therapy is focused on relaxing the body and

mind in order to reduce muscle tension and quiet the mind (Jallo, Cozens, Smith, & Simpson,

2013).


I think that this therapy would help J.L. to relax and take time to clear her mind and focus

on something other than school and work. My plan for her would to practice guided imagery for

thirty minutes a day, somewhere she feels comfortable and undistracted. She should continue

doing this every day for one month starting 6/14/13. At the end of the month if the guided

imagery is working to alleviate some of the stress form her life than she should continue to do it,

if not a different therapeutic method should be used. I believe that stress reduction would greatly

affect J.L’s sleeping patterns and over-all health. In order to know if this intervention is working

I think that J.L. should keep a log of her stress levels every day. These levels should be rated on

a zero to ten scale, with zero being no stress at all, and ten meaning the stress levels are

unusually high. J.L. should log her stress levels before and after the therapeutic guided imagery.

Another intervention I have planned for J.L. would be a consistent exercise routine. This

does not have to be and strenuous workouts, but a walk or short jog at least three times a week

for at least a half hour at a time. I think that this would help with her stress levels and any

problems that she is having associated to weight. Exercise has been proven to boost the

neurotransmitter endorphins in the brain that are linked to feeling good. It allows you to focus on

body movement instead of all the daily stressors in life. It can also boost one’s self-confidence

and lowers feeling of depression and anxiety (Mayo Clinic, 2013). I think that J.L. should find

something that she enjoys doing in order for her to stay interested in it, and stick to a plan of

physical activity three times a week for one month starting 6/14/13. She should keep a log of

what she does each day and the amount of time dedicated to physical activity each day.

Readiness for Change

In order for someone to change their behavior they have to want to change. If they are

forced into changing more than likely they will relapse into old behaviors. The Transtheoretical


Model of Change was developed as the basis for effective interventions as they relate to

promoting healthy behavior changes. This model describes how people modify their behaviors

or acquire positive behavior. This model has developed several different stages of change that

focus on the decision making of the individual. This model looks at change to have five different

stages. The first stage is precontemplation in which individuals do not intend to change in the

near future. Contemplation is the next stage in which the individual intends to change their

behavior within the next six months. Preparation is the stage in which the individual intends on

changing their behavior within the next month. Action is the fourth stage in which individuals

have modified their behaviors with-in the past six months. The final stage is the maintenance

stage in which individuals take steps in order to prevent relapses to their behavior changes.

Regression can occur if an individual regresses to an earlier stage in the behavioral changing

process (Velicer, Fava, Porchaska, Norman, & Redding, 1998)

I believe that J.L. is in the preparation stage because she knows that she needs to change

and wants the change for herself to become a healthier person. I think that she will make a plan

to change and stick with it, and I think she is ready to change within the next month or so. She

needs to educate herself how what kinds of changes she is willing to make in order to come up

with a solid plan. This will make it easier to stick to a schedule and lessen the chances of

regression to bad habits.

Evaluation

I believe that the progress J.L. has made over that last week has shown to her that

positive feelings of stress reduction come out of the goals and interventions we set. Although

the ultimate goal was set for a month, if she continues on the path she is on now, I believe she

will make positive changes to both her sleep patterns and her stress levels. Appendix C shows a


log of her stress levels before and after guided imagery which tend to show reduced feelings of

stress after a half hour of this therapy. She did state that it feels weird and unnatural to lay there

and try to relax and focus on her mind instead of her stressors. This tells me that guided imagery

may not be the best intervention for her to follow because if she doesn’t feel comfortable with it

then she will be more likely to regress to bad habits. I would suggest she try other forms of

therapy until she finds one that works for her that she is comfortable with and enjoys doing. She

could stop the therapy now and try something new, or continue with the guided imagery for the

full month and see if she still feels the same way about it.

The most progress was seen with the second intervention of exercise. J.L. showed

improvements to her stress levels and enjoyed doing different activities. Although she tried a

few different things to get exercise for the week, she found out that she most enjoyed walking

her dog. It is important to enjoy the activates being performed in order to decrease the risk for

regression. My suggestion for J.L. would be to continue with the planned intervention for the

full month and at that time set a permanent schedule. Appendix D shows an exercise log for the

past week. After a week of moderate physical activity, J.L. stated that she feels less stressed

after activity and looks forward to it. This is important because if the activity is enjoyed it will

be easier to stick to. J.L. has also had improvements in her duration and quality of sleep on the

nights that she performs activity. Appendix E is a memo I sent to the client about her progress

thus far and any changes that should be made to her planning.

If this client sticks to the current plan, her stress levels should go down and her sleeping

habits should continue to improve. With improved sleeping habits she should wake feeling

rested and ready to perform daily tasks essential to living a healthy and active lifestyle. These


things should reduce her risk for disease and infection and help her to remain healthy and active

for many years to come.


Appendix A

Real Age results


Appendix B

Sleep log for the week of May 27th – June 2nd 2013

Day Time: wake up Time: went to bed # of hours asleep

Monday 4:30 am 10:00 pm 6.5

Tuesday 8:00 am 11:30 pm 8.5

Wednesday 10:00 am 2:00 am 8

Thursday 8:00 am ---------------- 0

Friday 3:00 PM 7:00 AM 8

Saturday 5:00 AM 12:00 PM 5

Sunday 9:00 AM 10:00 PM 11


Appendix C

Guided Imagery Stress Log

Amount of Stress 0-10 Before GI After GIMonday 6 4Tuesday 7 3Wednesday 4 4Thursday SKIPPED SKIPPEDFriday 9 7Saturday 6 5Sunday 3 4


Appendix D

Daily Activity Log

Daily Activity Type of Activity Duration of activityMonday 1 mile walk 15-20 minutesTuesday 1.5 mile walk 30 minutesWednesday Swim (indoor pool) 30 minutesThursday Dog walking 30 minutesFriday Dog walking 45 minutesSaturday SKIPPED SKIPPEDSunday Bike ride 20-30 minutes


Appendix E

Dear J.L.,

I am writing you in regard to our pervious discussion of your health and well-being. After seeing and reviewing your results I believe that you are taking some great steps in becoming a healthier and better version of yourself. I think that you have shown much improvement in your stress management, and stress levels. I believe you should continue to work toward the goal that we set and realize that there will be positives and negatives on your journey to better health.

I think it is great that you found a form of exercise that you enjoy and that fits into your schedule. You should continue to gradually increase your goals until you are satisfied with the accomplishments you have made. Exercise is going to continue to improve your health and have a positive effect on your sleeping habits. Just know that someone is always here to help you and guide you if you are ever feeling lost on your journey.

If guided imagery is not your personal preference when it comes to therapies, then you should find something else that you enjoy that works to help manage your stress levels and relaxes your mind, body, and spirit. There are many different types of therapies out there to try, and when you find one you like, stick with it. If you would like more guidance into these different types of therapies please feel free to contact me. Keep up the great work; you have accomplished so much in just a short amount of time. I have no doubt in my mind that you are on the road to becoming a healthy, well-rounded, holistic version of yourself, and your bad habits will be left in the past.

Thank You,

Whitney Ayers

[email protected]


References

Jallo, N., Cozens, R., Smith, M., & Simpson, R. (2013, June). Effects of a Guided Imagery

Intervention on Stress in Hospitalized Pregnant Women: A Pilot Study. Holistic Nursing

Practice, 27(3), 129-139. http://dx.doi.org/10.1097/HNP.0b013e31828b6270

Massey, T. (2012, November 1). The risks of falling asleep on the job. Occupational Health,

64(11). Retrieved from CINAHL Database

Maville, J. A., & Huerta, C. G. (2013). Health Promotion in Nursing (3rd ed.). Cliffton Park, NY:

Delmar.

Mayo Clinic (2013). Stress Management. Retrieved from

http://www.mayoclinic.com/health/exercise-and-stress/SR00036

Niu, S., Chu, H., Chung, M., Lin, C., Chang, Y., & Chou, K. (2012, April 3). Sleep quality in nurses:

A randomized clinical trial of day and night shift workers. Biological Research for

Nursing, 15(3). http://dx.doi.org/10.1177/1099800412439459

Oz, D., & Roizen, D. (2013). RealAge. Retrieved from www.realage.com

Sparks, S., & Taylor, C. (2010). Nursing diagnosis reference manual. New York, NY: Lippincott &

Williams.

Velicer, W., Fava, J., Porchaska, J., Norman, G., & Redding, C. (1998). Transtheoretical Model.

Retrieved from http://www.uri.edu/research/cprc/TTM/detailedoverview.htm

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