1.Women and the Importance of Sleep Sleep Debt and Clinical Sleep Disorders are Often Unrecognized, Untreated, and Misdiagnosed in Millions of Women Anne L. Smalligan, BSN, Med. with Kaye Renshaw, LPC

2. Strength doesn't lie in numbers Strength doesn't lie in wealth Strength lies in nights of peaceful slumber When you wake up Wake up! It's healthy!From The Sound of Music I Have Confidence 3. The Alarming Statistics 50% of all sleep disturbances are due to stress 63% of adults do not get enough sleep to regulate weight 75% of Strokes have related Sleep Apnea People who sleep five hours or less are 40% more likely to have a heart attack 4. SLEEP and the Brain/Mind Sleep allows the brain to organize events of the day Adequate sleep is necessary to erase and efficiently store events Inadequate sleep leaves the task unfinished Events pile up causing the mind to race Concentration is interrupted Decision making is hindered 5. The Vicious Cycle Events of the Day Depression, Anxiety, Memory loss, ILLNESSDecreased Sleep Resulting in a pressured pace coping with normal daily eventsIncomplete processing through inadequate sleepEvents from one day to the next pile up 6. Sleep Loss Risk of Other Illnesses Diabetes Hypertension Obesity Heart Disease Immune Deficiency Psychological DisturbancesThe list is UNENDING 7. Sleep Loss Increases Effects of Aging Including Memory Loss 8. Medical vs. Mental Causes Medical conditions should be ruled out before embarking on a stress-related diagnosis and treatment Often a team approach, health care providers and counselors can be more effective to get you back on a normal sleep cycle 9. Her Sleep vs. His Sleep Do women and men sleep the same? 10. Her Sleep vs. His Sleep Do women and men sleep the same? WomenMen Sleep quality Sleep quality Sleep times Sleep times Sleep onset/latency Sleep onset/latency Sleep efficiency Sleep efficiencyCurr Opin Pulm Med. 2006 Nov; 12(6):383-9 11. Thats the Good News Despite these positive differences, women have more sleep-related complaints than men! 12. These Conditions are Clinical Disorders That Probably Require Medical Attention in Both Men and Women Insomnia Restless Legs Syndrome (RLS) Obstructive Sleep Apnea 13. Insomnia An inability to fall or stay asleep that can cause a negative impact on your ability to function throughout the day. 14. Insomnia is Diagnosed by: Difficulty falling or staying asleep or nonrestorative sleep Sleep difficulty three times a week for at least one month Difficulty sleeping despite opportunity and circumstances to sleep Daytime distress or impairment caused by lack of sleep 15. Restless Legs Syndrome (RLS) An unpleasant creeping sensation associated with aches and pains throughout the legs that can make it difficult to fall asleep. 16. Obstructive Sleep Apnea (OSA) Interrupted sleep caused by periodic gasping or snorting noises or momentary suspension of breathing. 17. Women Report: Insomnia (especially with increased age) Restless Legs Syndrome Obstructive Sleep Apnea (OSA) 18. Why is an OSA Diagnosis Difficult to Come by in Women? The typical people suffering from OSA have been categorized; 1. Male 2. Middle aged 3. Overweight or obese 19. Why is an OSA Diagnosis Difficult to Come by in Women? Women and men report different symptoms when they are suffering from Obstructive Sleep Apnea. 20. Reported Symptoms of OSA WomenMen Fatigue Snoring Insomnia Witnessed breathing Morning Headache Mood disturbancespauses Excessive sleepiness 21. Other Female-Only Issues That Can Alter Sleep Menstrual cycles Pregnancy Menopause 22. The Hormonal Picture Chronic Sleep DebtWeaken Immune SystemIncrease cravings for CarbsDecreases production of Thyroid Stimulating Hormone Increased levels of Cortisol or stress hormonesMay decrease growth hormone and testosteroneMay decrease glucose tolerance 23. If you dont have a clinical sleep disorderwhat is keeping you awake? 24. What is Keeping us Awake? Finances Family | Children Work 25. Did You Know? Eating a high calorie meal or late night snack near your bedtime is associated with lower quality of sleep -- especially in women! 26. Did You Know? The more calories consumed- the longer it took women to fall asleep.So, dont eat after 7 pm it is also a good idea to help you maintain or lose weight! 27. Mood Disorders are Increased with Inadequate Sleep Adjustment Disorders Depression Anxiety 28. Symptoms of Mood Disorders Signs and symptoms of adjustment disorder may affect how you feel and think about yourself or life, including: Sadness & hopelessness Lack of enjoyment or crying spells Nervousness or worry Thoughts of suicide Desperation Trouble sleeping Difficulty concentrating Feeling overwhelmed 29. Behavioral Symptoms of Mood Disorders Signs and symptoms of adjustment disorder may affect your actions or behavior, such as: Fighting Ignoring bills Avoiding family or friends Poor school or work performance Absenteeism Forgetting important events/appointments 30. AndReckless Driving 31. Symptoms Over Time Symptoms persisting less than a few weeks may go away on their own with self care Symptoms persisting over several weeks may not go away on their own.SEEK HELP Make an appointment with your health practitioner Medication may be necessary to resolve the issue 32. How Much Sleep Do You Need? Sleep requirements vary from person to person Most adults need seven to nine hours of sleep per night If you dont get your required amount of sleep, you begin to accumulate Sleep Debt 33. Pay Down Your Sleep Debt You must pay yourself with an increase in sleep: If you need eight hours of sleep and you have a debt sleep 9-10 hours per night until you no longer feel tired during the day. After paying the debt you can return to sleeping your required amount. 34. Coping with Stress Improving Sleep Be Intentional; Set routines Go to bed earlier Eliminate stimuli 35. Coping with Stress Improving Sleep Plan Stress Relief; Walk instead of running Take a bubble bath Order take out Get a massage 36. Coping with Stress Improving Sleep Demand the opportunity for self care; Practice assuming permission Be vulnerable with a: Friend Counselor Minister 37. Improve Sleep by: Avoiding caffeine Journaling thoughts and close the book Getting into bed Turning all lights off Turning all sound off Doing relaxation exercises 38. Tips to Reduce Stress and Reduce Sleep Debt Breathe Effectively Eat Healthy Stretch | YOGA Massage Therapy 39. Sleep Hygiene Go to bed and get up at the same time each day Sleep in a quiet, dark and relaxing environment Have a comfortable temperature in your room Your bed is for sleeping and sex only! Remove TVs, computers and other gadgets from your bedroom Avoid large meals and snacks before bedtime CDC Features- Sleep and Sleep Disorders 40. What about Sleep Aids and Medications? Non-pharmacy sleep aids -- use them if they are helpful to you; Sound machines Eye masks 41. Sleep Aids and Medications Prescription Medications; Benzodiazepine Sleep Aids Non-Benzodiazepine Sleep Aids Melatonin Receptor Agonists (Rozerem) for Falling Asleep Antidepressants as Sleep AidAll of these medications have side effects and most lose effectiveness over time. Discuss their use with your health care provider. 42. Sleep Aids and Medications Over-the-counter medications; Melatonin -- A naturally occurring hormone that is sold as a health supplement. The research on its effectiveness as a sleep aid is limited to specific cases and its use should be discussed with your health care provider. 43. Gender Differences and Medications March 2013 FDA Label Change FDA recommended a dosing change for Ambien, a common sleep drug The maximum dose recommended for women was reduced from 10mg to 5mg Women metabolized (used) this medicine at a slower rate More active drug was left in the system the next day causing increased risk for side effects: sleep eating, sleep driving, headaches, and daytime grogginess 44. Ambien Approved 20-plus Years AgoWe are now recognizing this significant difference because during the application for a new sleep aid Intermezzo (zolpidem) a teams evaluation data looked at gender. This resulted in a dosing change for women. 45. A recent publication revealed that 8 out of 10 drugs pulled from the market between 1997-2000 had more adverse events (side effects and death) in women 46. Take Home Tips 1. Not sleeping enough is harmful 2. Pay your sleep debt 3. Talk with your doctor if you are not sleeping 4. Sleep hygiene works 5. Medical illnesses can cause insomnia and can lead to serious health outcomes 6. Medications can be useful: start low and go slow to avoid side effects 47. Remember Sufficient sleep is not a luxury- it is a necessity- and should be thought of as a vital sign of good health. Wayne H. Giles, MD, MS 48. References http://www.sleepdex.org/deficit.htm J Womens Health (Larchmt). 2008 Sep;17(7):1191-9. doi: 10.1089/jwh.2007.0561. Rev Neurol. 2009 Oct 1-15;49(7):376-82. Curr Opin Pulm Med. 2006 Nov; 12(6):383-9. J Clin Sleep Med. 2011 Dec 15;7(6):659-64. doi: 10.5664/jcsm.1476. http://www.webmd.com/sleepdisorders/news/20100115/sleep-debt-hard-to-repay http://www.nhlbi.nih.gov/health/dci/Diseases/rls/rls_WhatIs.ht ml