The Importance of Stress

Management and Sleep for

Lawyers

January 30, 2018

Roman Hruska Law Center, Lincoln, NE

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The Importance of Stress Management and Sleep for Lawyers

By: Elise McHatton, MA, ACSM-HFS, NSCA-CSCS

Director Of Account Management

SimplyWell, LLC

Objectives

• Understand the affects of stress on the body and mind.

• Understand the benefits of relaxation.

• Understand how better management of stress will benefit your clients and help you fulfill your ethical duties to the judicial system, the public, clients, and other attorneys.

• Understand what sleep is about.

• Identify sleep disorders and understand the consequences of sleep deprivation.

• Explore proper sleep hygiene.

– Neb. Ct. R. of Prof. Cond. §§ 3-501.1, .3, .4

True or False

1: In an ideal world, there would be no stress.

2: What is stressful to me is stressful to you.

3: Only unpleasant situations are stressful.

4: No symptoms, no stress.

5: Stress in inevitable, so you can’t do anything about it.

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Stress

• Bumper-to-bumper traffic

• A deadline fast approaching

• Illness, cancer, disease

• Arguments with clients, coworkers, spouse or friends

• Unpaid bills

• Worrying

• These scenarios are actually stressors – stressful events and circumstances.

What does stress mean to you?

What is Stress?

• Stress is a demand made upon the adaptive capacities of the mind and body.

• Each real or perceived threat to our body triggers a stress response that produce physiological changes to our bodies.

Sources of Stress

• Environmental

• Social

• Physiological

• Thoughts

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The Stress Response

1. Hypothalamus sends chemical messenger to the pituitary gland.

2. Pituitary glands send a signal to the adrenal glands (into the bloodstream).

3. Surges of epinephrine, norepinephrine and cortisolare released.

4. Stress hormones prepare your body for flight or fight.

5. Breath quickens.

6. Alertness increases.

7. Heart beats faster.

8. Blood cells become thicker to minimize bleeding from potential injuries.

9. Body systems not needed are suppressed.

Fight or Flight Response

Cortisol- Over-ExposureAbdominal Fat Deposition – high levels of cortisol induce the body to deposit fat in the abdomen, upper back and neck. (High Blood Pressure, Type II Diabetes, and Heart Disease)

Increased Blood Sugar Levels – gluconeogenesis – promotes the breakdown of bodily tissues in order to increase blood sugar.

Muscle Breakdown – prolonged elevated levels can lead to muscle wasting.

Decreased Immunity – inhibits the actions of white blood cells, leads to susceptibility to infections and other illnesses. Suppression of the immune system has implications for asthma, GI disorders, cancer, and ulcers.

Speeds up aging process – 2004 study of mothers of chronically ill children – ‘shortened telomeres.’

Increased appetite – studies show that people with higher levels of cortisol tend to eat more carbohydrates.

Increased inflammation – chronic inflammation linked to chronic disease processes

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Stress

Fact: Stress will always be a part of daily living and is necessary for providing challenge to physiological and psychological development.

However, too much stress over a period of time combined with poor coping habits may cause physiological harm leading to illness and possibly death. Studies have shown a high correlation between prolonged stress and illness.

• Especially among lawyers, too much stress can also cause job dissatisfaction, burnout, depression, and substance abuse which, in turn, cause ethical violations, malpractice and various types of unprofessional behaviors.

• The core values contained in the Nebraska Rules of Professional Conduct, such as integrity and civility, require lawyers to manager their stress levels by reducing their dysfunctional negative thoughts and emotions (e.g., anger).

Stress Break-Breathing

Stress = Success

Distress=Too little Distress=Too much

Eustress =Right amount of

stress

BoredTiredUnhappyRestlessProne to illness

ProductiveEnergetic

HappyCreativeHealthy

Client Focused

Burned outExhaustedOverweight/UnderweightIrritableProne to illness

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Stress

• Acute Stress-short-term stressor

-quick appearing

-very intense

-vanishes quickly

• Chronic Stress-long-term stressor

-unrelenting demands

-extended period of time

-stress related disease

Toll of Chronic Stress

• Prolonged stress response can cause a poor distinction between life-threatening events and day-to-day stressors.

• Stress response kicks in too soon or too often, burdening the body.

• Stress’ Contribution to health problems:

– Allergic skin reactions

– Anxiety, Depression

– Constipation/IBS

– Dizziness, headaches

– Heart problems, such as angina, heart attack, and cardiac arrhythmia

– Hypertension

– Insomnia

– Pain

– Ulcers

Learning Stress Triggers

Do you feel any of these?• Tight neck and shoulders

• Tiredness and Fatigue

• Dizziness or Fainting

• Stomachache/Indigestion

• Restlessness

• Bossiness

• Emotional eating

• Anger/Anxiousness

• Depression

• Worry

• Poor Concentration

• Short term memory loss

Being able to recognize when you feel stressed can help counteract the stress response.

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Stress Management = Health

Positive attitude Letting go of resistance Relaxation techniques Proper nutrition Movement Sleep Rational thinking Change in perception

Stress Management for Life

1. Eliminate the stressor = Confront the problems which cause you stress and change or eliminate their source.

2. Change your thinking = You have the power to change your interpretation of the situation and the way you think about it.

3. Manage the stress = Manage the stressors through coping skills.

Stress Break- Guided Imagery

https://youtu.be/dEzbdLn2bJc

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Relaxation Defined

• The process of effectively moving the mind/body from the stress response to the relaxation response.

• A state of decreased psycho-physiological arousal: a calming state.

Benefits of Relaxation

• Slows heart rate

• Reduces blood pressure

• Slows breathing

• Reduces oxygen demand

• Increases blood flow to major muscles

• Lessens muscle tension

• Fewer symptoms of illness

• Fewer pains such as headaches and muscle pains

• Less nausea/GI upset

• Fewer emotional responses (anger, crying, anxiety, frustration)

• More energy

• Improved concentration

• Better ability to handle problems

• Efficiency in daily activities

Stress Management/Relaxation Techniques

• Power Nap

• Breathing

• Autogenics – self-directed relaxation using suggestions to create feelings of warmth and heaviness in the body

• Progressive Relaxation – designed to specifically reduce muscle tension through focused attention

• Guided Imagery – used to connect the subconscious mind to activate the relaxation response

• Meditation – letting your mind focus on a single item

• Yoga

• Healing Touch Therapy

• Music

• Laughter

• Exercise/movement

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4 Steps to Stopping Stress

1. Consciously call a mental time-out. The next time you feel stressed, simply say

"Stop.“

2. Breathe. Take a few deep breaths to reduce physical tension and help you relax.

3. Reflect. Ask yourself the following questions: Is this thought or belief true? Did I jump to a conclusion? Is there another way to view the situation? Does it help me to think this way?

4. Choose. Decide how to deal with the source of your stress.

Challenge your thinking and adjust your view of reality.

Substance Abuse

• Chronic stress is a well-known substance abuse risk factor

• Avoidance of alcohol and drugs for ‘stress management’

Stress Break- Progressive Relaxation

https://youtu.be/9x3tl81NW3w

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Homework-Daily Stress Diary

During the day, list situations or events which initiate the stress response and include for each:

– Source

– Time and Place

– Level of Perceived Stress (1-slight, 2-moderate, 3-strong, 4-intense)

– Thoughts and Feelings about the Stressor

– Coping Strategies

Assess and look for common themes. Reflect on coping strategies which worked for you.

Sleep 101

About Sleep

• Active process

• Some brain activity increases during sleep/recharges

• Release important hormones

• Cells repair themselves

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How much is enough?

• Adults – most need 7 ½ - 8 hours

• Approximately 10% require more or less sleep

Sleep Patterns

• Non-REM– Stages 1-4

– Restorative functions of sleep occur

• REM– Stage 5

– Memories and thoughts from the day are processed

Stages of Sleep

• Stage 1– Light sleep, awaken easily

– Slow eye movement, muscle activity begins to slow down

• Stage 2– Brain waves are slower with occasional

bursts of rapid waves

– Eye movement stops

• Stage 3– Extremely slow brain waves – Delta

waves

– Considered deep sleep

• Stage 4– Almost exclusively Delta waves

– Deep sleep

• Stage 5 - REM– Brain waves increase to wake levels

– Dreams

– Increase in BP, HR and respirations

– Rapid movement from eyes

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Sleep Deprivation an Epidemic?

• 50-70 million US adults have a sleep disorder

• 37.9% unintentionally fall asleep during the day

Common Sleep Disorders

• Snoring/Apnea

• Insomnia

• Narcolepsy

• Restless leg syndrome

• More than 80 different disorders

Symptoms of Sleep Problems

• Decrease in performance

• Behavioral issues

• Irritable

• Hyperactive

• Frequent Illness

• Headaches, jaw pain, earaches

• Depression/anxiety

• Daytime sleepiness

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Signs of Sleep Deprivation

• Napping easily

• Needing an alarm to wake

• Falling asleep within minutes of hitting the pillow

General

• $16 Billion = direct cost of sleep related problems

• $50-100 Billion = indirect cost

• 20% of adult sleepiness interferes 2 or more days per week

• 4 out of 10 adults report sleepiness interfering with activities a few days a month

Impaired Functioning

• 1 night of sleep deprivation = legal intoxication

• 2-4 x’s greater risk of accidents

• Notable disasters have been contributed by errors in judgment from fatigue and sleepiness

• Work performance while accidents

• 36% increase in medical errors

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Why so important?

Health Consequences

• Increase in heart disease

• Endocrine system challenges

• Immune system compromised

• Nervous system issues

• Mental health

• Early death

Sleep Hygiene

• Relaxing routine

• Regular sleep schedule

• Limit stimulating behaviors before bed

• Physically active during the day

• De-stress

• Not too hungry or full

Practice Stimulus Control

Limit other activities in your bed

Go to bed when you’re drowsy

Temperature control in your room

Low lights

If you don’t fall asleep within 10-15 minutes, get up

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Did you know?

• What animal sleeps the least?– Giraffe at 1.9 hours

• What animal sleeps the most?– Koalas at 22 hours

Symptoms of Stress Worksheet

Symptoms Frequency of Symptoms

Almost all day, every day

2-3 times a day

Every night or day

2-3 times per week

Once a week

Once a month

Never

Headaches

Tense muscles: sore neck/back

Fatigue

Worry, anxiety, phobias

Difficulty falling asleep

Irritability

Insomnia

Bouts of anger/hostility

Boredom, depression

Eating too much/too little

Diarrhea, cramps, gas, constipation

Restlessness, itching

Grinding teeth, clenching jaw during sleep

Difficulty concentrating

Source: Stress Management for Life, Olpin and Hession, 2014

Perceived Stress Scale For each question choose from the following alternatives: 0 - never 1 - almost never 2 - sometimes 3 - fairly often 4 - very often ________ l. In the last month, how often have you been upset because of something that happened unexpectedly? ________ 2. In the last month, how often have you felt that you were unable to control the important things in your life? ________ 3. In the last month, how often have you felt nervous and stressed? ________ 4. In the last month, how often have you felt confident about your ability to handle your personal problems? ________ 5. In the last month, how often have you felt that things were going your way? ________ 6. In the last month, how often have you found that you could not cope with all the things that you had to do? ________ 7. In the last month, how often have you been able to control irritations in your life? ________ 8. In the last month, how often have you felt that you were on top of things? ________ 9. In the last month, how often have you been angered because of things that happened that were outside of your control? ________ 10. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? You can determine your PSS score by following these directions: • First, reverse your scores for questions 4, 5, 7, and 8. On these 4 questions, change the scores like this: 0 = 4, 1 = 3, 2 = 2, 3 = 1, 4 = 0. • Now add up your scores for each item to get a total. My total score is ___________. • Individual scores on the PSS can range from 0 to 40 with higher scores indicating higher perceived stress. ► Scores ranging from 0-13 would be considered low stress. ► Scores ranging from 14-26 would be considered moderate stress. ► Scores ranging from 27-40 would be considered high perceived stress. Source: https://das.nh.gov/wellness

Sleep Assessment Test The Epworth Sleepiness Scale is used to determine the level of daytime sleepiness. A score of 10 or more is considered sleepy. A score of 18 or more is very sleepy. If you score 10 or more on this test, you should consider whether you are obtaining adequate sleep, need to improve your sleep hygiene and/or need to see a sleep specialist. These issues should be discussed with your personal physician. Even if you have not done some of these things recently, try to determine how they would affect you now. Use the following scale to choose the most appropriate number for each situation: 0 = would never doze or sleep. 1 = slight chance of dozing or sleeping 2 = moderate chance of dozing or sleeping 3 = high chance of dozing or sleeping Read the Situation and Decide What Number Fits Your Chances of Dozing or Sleeping: ____ Sitting and reading ____ Watching TV ____ Sitting inactive in a public place ____ Being a passenger in a motor vehicle for an hour or more ____ Lying down in the afternoon ____ Sitting and talking to someone ____ Sitting quietly after lunch (no alcohol) ____ Stopped for a few minutes in traffic while driving Add up all your numbers. This is your Epworth score: ______________ Score Results: 1-6: within normal limits 4-8: moderate sleepiness. You may want to discuss your results with your physician. 7-9: Excessively sleepy. Discuss your results with your physician. Source: https://www.nebraskamed.com/sleeping/sleep-assessment

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Tips for Better Sleep

Daily activities:

Exercise during the daytime, avoid energetic or stressful activity in the evening or before bedtime

Maintain a regular meal schedule and limit caffeine

Avoid naps

Don’t smoke or use tobacco products

Evening and bedtime routine:

Try to go to bed and awaken at the same time every day, even on weekends

Allow at least one hour to unwind before bed

Use dim light during your pre-bed routine

Don’t drink alcohol before bedtime

Sleep environment:

Sleep only in the bedroom and keep it quiet, dark and at a comfortable temperature

If you need a nightlight, use a red bulb

Consider a sleep mask, earplugs, or white noise machines to block out noise

When it is hard to fall asleep:

Go to another room and do a quiet or boring activity until you feel very sleepy

Try a relaxation technique

Stress and Your Health

Recognize stress:

Tight neck and shoulders

Tiredness/fatigue and dizziness/fainting

Stomachache or indigestion

Anger, anxiousness or bossiness

Depression or worry

Emotional eating

Poor concentration or restlessness

Short-term memory loss

Keys to managing your stress:

Positive attitude

Rational thinking

Changing perceptions

Letting go of resistance

Healthy eating and exercise

Good sleep routine

Relaxation techniques

STOP – BREATHE – REFLECT - CHOOSE