valerie cherry, phd lead mental health specialist john kulig, md, mph lead medical specialist sleep...
TRANSCRIPT
VALERIE CHERRY, PHD
LEAD MENTAL HEALTH SPECIALIST
JOHN KULIG, MD, MPH
LEAD MEDICAL SPECIALIST
Sleep from A to Zzzzz: Sleep Hygiene for Job Corps Students
2Behavioral and Medical Strategies to Help Job Corps Students Sleep
After this presentation, participants will be able to:
Describe the Job Corps student's recommended sleep requirements and different types of sleep disorders in order to improve assessment and intervention on center.
Define "Sleep Hygiene" and describe at least five ways to help students improve sleep patterns in the Job Corps setting.
Utilize simple and practical cognitive behavioral strategies to help students improve sleep patterns.
Describe the options and indications for pharmacotherapy for sleep disorders.
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Sleep Requirements
12 TO 18 YEARS OLD:
8½ – 9½ HRS/NIGHT
ADULTS (18+):
7½ - 8 HRS/NIGHT
5Signs of Sleep Deprivation
Need an alarm clock in order to wake up on time.
Have a hard time getting out of bed in the morning.
Feel sluggish in the afternoon.
Get sleepy in meetings, lectures, or warm rooms.
Get drowsy after heavy meals.
Fall asleep while watching TV or relaxing in the evening.
Feel the need to sleep in on weekends.
6Effects of Sleep Deprivation
Fatigue, lethargy, and lack of motivation
Moodiness and irritability
Reduced creativity and problem-solving skills
Inability to cope with stress
Concentration and memory problems
Impaired motor skills and increased risk of accidents
Difficulty making decisions
Reduced immunity; frequent colds and infections
Weight gain
Increased risk of diabetes, heart disease, and other health problems
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Sleep Disorders
INSOMNIA
SLEEP APNEA
CIRCADIAN RHYTHM DISORDERS
9Insomnia
Inability to get the amount of sleep needed to wake up feeling rested and refreshed is the most common sleep complaint.
Often a symptom of another problem, such as stress, anxiety, depression, or an underlying health condition.
Can also be caused by lifestyle choices, including lack of exercise, substance use, medications, or even the amount of caffeine consumed.
Symptoms of insomnia include: Difficulty falling asleep at night or getting back to sleep after waking during
the night
Waking up frequently during the night
Sleep feels light, fragmented, or exhausting
Sleepiness and low energy during the day
10Sleep Apnea
A common sleep disorder in which breathing temporarily stops during sleep due to blockage of the upper airways. These pauses in breathing interrupt sleep, leading to many awakenings each hour.
Symptoms of sleep apnea include:
Loud, chronic snoring
Frequent pauses in breathing during sleep
Gasping, snorting, or choking during sleep
Feeling exhausted after waking and sleepy during the day, no matter how much time spent in bed
Waking up with shortness of breath, chest pains, headaches, nasal congestion, or a dry throat
Assessment by center physician is indicated
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12Circadian Rhythm Disorders
A circadian rhythm is an internal biological clock that regulates our 24-hour sleep-wake cycle.
Light is the primary cue that influences circadian rhythms.
Disruption in circadian rhythms may cause grogginess, disorientation, and sleepiness at inconvenient times.
Circadian rhythms have been linked to a variety or sleeping problems, including insomnia, jet lag, and shift work sleep difficulties.
Abnormal circadian rhythms have also been implicated in depression, bipolar disorder, and seasonal affective disorder (the winter blues).
May be an issue for Job Corps students upon arrival – sleeping during the day at home, change in time zones
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Sleep Hygiene
TIME TO REBOOT
LOL...OMG...IDK:
WHY AM I SO TIRED?
14What is Sleep Hygiene?
The promotion of regular sleep is known as sleep hygiene.
Sleep hygiene is a variety of different practices that are necessary to have normal, quality nighttime sleep and full daytime alertness.
Why important?
Putting good sleep habits into practice is particularly difficult while at Job Corps and for this age group.
15General Tips to Promote Sleep and Healthy Lifestyle
During the day: Limit or avoid caffeine, alcohol and nicotine
Exercise, but not too close to bedtime
Establish a regular bedtime routine Engage in a relaxing, non-alerting activity before bedtime
Reading, Music, Meditation, Breathing Exercises
Do not drink or eat too much close to bedtime
Maintain a quiet, dark and preferably cool, but comfortable sleep environment
Keep a sleep diary to identify sleep habits and patterns.
Source: National Sleep Foundation
16Ways for Students to Have Better Sleep in Job Corps
Does student feel safe in dorm?
Is it related to health condition and/or medication?
Education. Make getting enough sleep a goal like any other goal. Build a plan that helps the student focus on it and get the results they want!
Relax your mind. Avoid violent, scary, or action movies or television shows right before bed — anything that might set your mind and heart racing.
Ear Plugs, headphones, and/or white noise sound app to make room quiet.
17Ways for Students to HaveBetter Sleep in Job Corps
Eye mask to help make room dark.
Log off instant messenger, Facebook, and email.
Turn off cell phone (don't just set it on vibrate) when it's time for bed.
Wake up with bright light. Bright light in the morning signals your body that it's time to get going. If it's dark in the dorm room, turn on a light as soon as the alarm goes off.
18Consequences for Students
Not getting enough sleep or having sleep difficulties can:
Limit ability to learn, listen, concentrate and solve problems.
Lead to aggressive or inappropriate behavior such as yelling at friends or being impatient with center staff or family members.
Cause students to eat too much or eat unhealthy foods like sweets and fried foods that lead to weight gain.
Contribute to poor health and to visits to the Health and Wellness Center
Lead to not using equipment safely and causing accidents.
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Cognitive Behavioral Strategies
20Cognitive Behavioral Strategies to Help Students Improve Sleep Patterns
Focuses on changing an individual's thoughts (cognitive patterns) in order to change his or her behavior and emotional state.
Interventions such as cognitive-behavioral strategies can be helpful for students who need additional support along with good sleep hygiene.
Anxiety, ADHD, depression, traumatic histories, or cognitive patterns that may make it hard to fall asleep.
21Strategies
Expect a good night's sleep: Instead of worrying that you won't sleep, remind yourself that you can. Say, "Tonight, I will sleep well" several times during the day.
Breathing Exercises: It can also help to practice breathing exercises before bed.
Relaxation techniques: Relaxation techniques such as progressive muscular relaxation can help sedate some people.
22Strategies
Visualizations: Picture a relaxing scene that involves sleep and build that scene in your mind.
Journal: Try keeping a diary or to-do lists. If you jot notes down before you go to sleep, you’ll be less likely to stay awake worrying or stressing. Use the note or memo feature on cell phone.
Sleep Restriction Therapy (SRT): Based on the belief that excess time in bed makes sleep problems worse. SRT consists of limiting a person's time in bed to only that time when they are sleeping.
23Sleep and ADHD
A lack of sleep can often be confused with attention-deficit/hyperactivity disorder (ADHD). The most common signs of a sleep problem that are shared by ADHD include the following: Trouble concentrating
Mood swings
Hyperactivity
Nervousness
Aggressive behavior
American Academy of Sleep Medicine. (2009, March 2). Underlying Sleep Problem Linked To Attention-deficit/hyperactivity Disorder In Children. Science Daily. Retrieved August 26, 2014 from www.sciencedaily.com/releases/2009/03/090301094248.htm
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Pharmacotherapy for Sleep Disorders
HERBAL/NATURAL SLEEP AIDS
OVER-THE-COUNTER SLEEP AIDS
PRESCRIPTION DRUGS
25Principles
Try non-pharmacological approaches first – lifestyle modification, environment, exercise.
Sleep medications are for short-term use only.
26Herbal/Natural Sleep Aids
Melatonin - naturally occurring hormone that increases at night triggered by darkness – 1 mg to 3 mg taken 60-90 minutes before bedtime
Valerian root – caution vivid dreams, blurred vision, changes in heart rhythm
L-tryptophan – amino acid used in the formation of the chemical messenger serotonin
St. John’s wort – caution drug interactions (OCPs)
Chamomile tea – caution allergies
27Over-the-Counter Sleep Aids
Most contain an antihistamine
Diphenhydramine (Benadryl, Nytol, Sominex)
Doxylamine (Unisom)
Hydroxyzine (Vistaril, Atarax) – not OTC – prescription anxiolytic
Common side effects of OTC antihistamine sleep aids:
Moderate to severe drowsiness the next day
Dizziness and forgetfulness
Clumsiness, feeling off balance
Constipation and urinary retention
Blurred vision
Dry mouth and throat
28Prescription Drugs for Sleep
Benzodiazepine sedative hypnotics [flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion)]
Non-benzodiazepine sedative hypnotics[zolpidem (Ambien), eszopiclone (Lunesta)]
Melatonin receptor agonist hypnotics[ramelton (Rozerem)]
Antidepressants [trazodone (Desyrel)]
29Prescription Drugs for Sleep: Adverse Effects
Physical and psychological dependence on benzodiazepines
Drug tolerance
Rebound insomnia
Headaches, dizziness, nausea, difficulty swallowing or breathing
In some cases, dangerous sleep-related behaviors such as sleep-walking, sleep-driving, and sleep-eating
New or worsening depression; suicidal thoughts or actions
30Resources
Sleep Hygiene Student Brochure
Health Care Guidelines for Sleep Hygiene—Coming soon!
Apps
White Noise
Breathing Exercise
Progressive Relaxation
Mindfulness Strategies
Sleep Diary/Journal
