Sleep Hygiene Fall 2011

Sleep “Hygiene”?

• Sleep hygiene refers to the habits, environmental factors, and practices that may influence the length and quality of one's sleep. These include bedtime, nighttime rituals, and disruptions to one's sleep.

How much sleep do I need?• A general guideline for adults is 7-8

hours of sleep a night. • Older adults need a similar

amount, but the sleep may be lighter and may include a brief nap during the day.

What happens when I don’t get enough sleep?

• Impaired mood, memory, and concentration

• Dampened immune system• Increased risk of accidents• Stressed relationships

How Much Is Enough?There are, generally, four categories of sleep behavior:

*Long sleepers vs. Short sleepers: some people need 9 or 10 hours of sleep in order to feel well, while others thrive on just 5 or 6 hrs.

*Rigid sleepers vs. Flexible sleepers: some people wake up at the same time every morning no matter what time they go to bed, even if they’ve slept only a few hours. Others can easily adjust their sleep patterns to accomodate changes in their normal social or work schedules.

*Larks vs. Owls: No doubt you’ve heard of this category already: the morning people-those who do their best work at the crack of dawn- and the night people- those who don’t really come alive until evening.

*Nappers vs. Non-nappers: some people are able to make up for lost sleep time by taking a nap, whereas others simply have to exist through the day until their next normal sleep perion. Dedictated nappers find that daily nap becomes an essential part of their sleep/wake pattern, and that they don’t function as well on days when they miss that afternoon snooze.

Aging

• After the age of 40 our sleep patterns change, and we have many more night-time awakenings than in our younger years. These awakenings not only directly affect the quality of our sleep, but they also interact with any other condition that may cause arousals or awakenings, like the withdrawal syndrome that occurs after drinking alcohol close to bedtime. The more awakenings we have at night, the more likely we will awaken feeling un-refreshed and un-restored.

Psychological Stressors

• Psychological stressors like deadlines, exams, marital conflict, and job crises may prevent us from falling asleep or wake us from sleep throughout the night. It takes time to "turn off" all the noise from the day. If you work right up to the time you turn out the lights, or are reviewing all the day's events and planning tomorrow (sound familiar?), you simply cannot just "flip a switch" and drop off to a blissful night's sleep.

How to deal with stressors

• Develop some kind of pre-sleep ritual to break the connection between all the stress and bedtime. This is perhaps even more important for children. These rituals can be as short as 10 minutes or as long as an hour. Some find relief in making a list of all the stressors of the day, along with a plan to deal with them, as it serves to end the day.

• Combining this with a period of relaxation, perhaps by reading something light, meditating, or taking a hot bath can also help you get better sleep. And don't look at that clock!

Social or Recreational Drugs• The effects of nicotine are similar to those of

caffeine, with a difference being that at low doses, nicotine tends to act as a sedative, while at high doses it causes arousals during sleep.

• Alcohol may initially sedate you, making it easier to fall asleep; however, as it is metabolized and cleared from your system during sleep, it causes arousals that can last as long as two to three hours after it has been eliminated.

Sleep Disorders - Facts

• Mood disorders often have sleep disruption as a chief complaint

• Major depression is characterized by either insomnia or hypersomnia

• Anxiety disorders often coexist with sleep disorders– Worry and nervousness lead to sleep disruption– Primary insomnia occurs in generalized anxiety, panic

disorder & posttraumatic stress disorder• 50% of elderly experience poor sleep• 94% of institutionalized are prescribed sedative-hypnotics• Males: 8 times the risk for obstructive sleep apnea

Types of Insomnia • Type 1) Sleep Onset Insomnia

When you cannot go to sleep, and usually have to lie in bed from 30 minutes to 3-4hours (or more) before you finally go to sleep, after much anxiety, stress, tossing andturning. You usually wake up with a massive headache, feeling drowsy, or with yourwhole body aching.

• Type 2) Sleep Maintenance InsomniaYou go to sleep normally, but you wake up during the night, once or several times,and you can't go back to sleep, or it takes a long time for you to go back to sleep.

• Type 3) Sleep Disturbance InsomniaYou go to sleep normally, you sleep for a normal amount of time (7-8 hours for adults,5-6 hours for the elderly), but you wake up un-rested, with a headache, aching,feeling drowsy, dizzy, etc.

Most Insomniacs suffer from a combination of type 1 and 2, if you suffer from type 3,you are most likely suffering from Sleep Apnea, or PLM (period limb movement), or

other underlying sleep disorders. Also, if you are pregnant it is very common toexperience type 3 Insomnia, especially in the last tri of pregnancy.

Medical Conditions & Sleep Disruption

• Fibromyalgia• Cystic fibrosis • Head injury• Migraine headaches• Huntington’s chorea• Tourette’s syndrome• Alzheimer’s disease• Cancer

• Arthritis• Chronic fatigue

syndrome• Hyperthyroidism• Menopause• Allergies• AIDS• Pain secondary to a

medical condition

Substance-Induced Sleep Disorder

• Antidepressants• Antihypertensives• Antihistamines• Corticosteroids• Stimulatants• Sedative-hypnotics

• Cholinergic agents• Cold preparations• Alcohol• Caffeine• Opioids• Amphetamines

Sleep Hygiene Tip

• Don’t go to bed unless you are sleepy– If you are not sleepy at bedtime,

then do something else. Read a book, listen to soft music or browse through a magazine. Find something relaxing, but not stimulating, to take your mind off of worries about sleep. This will relax your body and distract your mind.

Sleep Hygiene Tip

• If you are not asleep after 20 minutes, then get out of the bed. – Find something else to do that will

make you feel relaxed. If you can, do this in another room. Your bedroom should be where you go to sleep. It is not a place to go when you are bored. Once you feel sleepy again, go back to bed.

Sleep Hygiene Tip

• Adequate comfortable temperature

• Ensure absence of light• Reduce or eliminate noise• Remove TV & avoid listening to

radio in bed• Avoid other activities• Do not look at the clock when you

wake up at night

Sleep Hygiene Tip

• Avoid working in bed & set reasonable limit for finishing work prior to bedtime

• Avoid serious discussions or arguments prior to bedtime

• Avoid working on potentially upsetting things

Sleep Hygiene Tip

• Do not make late night phone calls• Exercise in the morning or several

hours before bed• Make bed and bedroom as

comfortable as possible• Do not turn lights on when getting

up during the night

Sleep Hygiene Tip

• Avoid alcohol• Avoid caffeine• Avoid OTC medications that cause

sleep problems• Establish regular pattern prior to

bed (brush teeth, change clothes)• Avoid naps

Sleep Hygiene Tip

• Protect bedtime and sleep from disruptions

• Minimize effects from bed partner (snoring, different bedtime, movement)

• Take hot bath within 2 hrs• Drink small amount of warm drink

(non- caffeinated)

A Word About Television• Many people fall asleep with the television on in their

room. Watching television before bedtime is often a bad idea. Television is a very engaging medium that tends to keep people up. We generally recommend that the television not be in the bedroom.

• Late night news or prime time shows frequently have disturbing, violent material. Even non-violent programming can have commercials which are jarring and louder than the actual program.

• Light and noise. The continuous flickering light coming from the TV (or a computer screen) can interfere with the body’s clock, which is sensitive to any light.

If These Hygiene Tips Don’t Work

• Several physical factors are known to upset sleep. These include arthritis, acid reflux with heartburn, menstruation, headaches and hot flashes.

• Psychological and mental health problems like depression, anxiety and stress are often associated with sleeping difficulty.

• Many medications can cause sleeplessness as a side effect.• To help overall improvement in sleep patterns, your doctor

may prescribe sleep medications for short-term relief of a sleep problem.

• Always follow the advice of your physician and other healthcare professionals.

• The goal is to rediscover how to sleep naturally.

Good night