Sleep Hygiene

Phyllis M.Connolly, PhD, RN, CS

Sleep Disorders Facts Mood disorders often have sleep disruption as chief

complaint Major depression characterized by either insomnia or

hypersomnia Anxiety disorders often coexist

Worry and nervousness lead to sleep disruption Primary insomnia occurs in generalized anxiety, panic

disorder & posttraumatic stress disorder 50% of elders experience poor sleep 94% of institutionalized prescribed sedative-hypnotics Males 8 times risk for obstructive sleep apnea

Characteristics Primary Sleep Disorders

Sleep Apnea DSM-IV 780.59

NarcolepsyDSM-IV 347

PrimaryInsomniaDSM-IV 307.42

CircadianRhythmDSM-IV307.45

daytimesleepiness,morningheadaches

daytimesleepiness

Difficultyinitiating ormaintainingsleep

Sleepscheduleconflict

Heavy loudsnoring

Cataplexy Daytimefatigue

Excessivesleepiness

Intervals ofbreathingcessation

Sleepparalysis

Awakingfeelingunrefreshed

Hallucinations

Sleep-Wake Pattern: Circadian Cycle Sleep cyclical 90 minute cycle

repeats 4 - 5 times during the night Stages (EEG pattern)

Stage 1--drowsiness and slowing of eye & muscle movements, lasts only few minutes

Stage 2-- light sleep, 10-25 minutes, muscles further relax (sleep spindles emerge)

Stage 3--deep sleep, few min. to 30 - 40 mins. VS & physical activity REM 5 -30 mins.

Stage 4--final stage of NREM, Slow wave EEG, 20 -40 mins.

Glod, 1998

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

Glod, 1998

Substance-Induced Sleep Disorder Antidepressants Antihypertensives Antihistamines Corticosteroids Stimulatants Sedative-hypnotics

Cholinergic agents Cold preparations Alcohol Caffeine Opiods Amphtemines

Methods of Evaluating Sleep Disorders Sleep Diaries History, Physical Exam, Detailed Sleep

Disorders Assessment Polysomnography (PSG) Multiple sleep Latency Test (MSLT) Actigraphy

Glod, 1998

Sleep Hygiene: Environment Adequate comfortable

temperature Ensure absence of light Reduce & 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

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

Glod, 1998

Sleep Hygiene: Environment Cont. Do not make late night

phone calls Exercise in morning or

several hrs. before bed Obtain 1/2 hr. sunlight

shortly after arising Make bed and bedroom as

comfortable as possible Do not turn lights on

when getting up during the night

Protect bedtime and sleep from disruptions

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

Take hot bath within 2 hrs

Drink small amt. Of warm drink (noncaffeinated) Glod,

1998

Sleep Hygiene Cont. Avoid alcohol Avoid caffeine Avoid OTC

medications that cause sleep problems

Establish regular pattern prior to bed (brush teeth, change clothes)

Avoid naps

Set regular bedtime and rise times, even weekends

Determine your individual amt. of sleep duration (6-10 hrs.)

Don’t sacrifice sleep If insomnia, daytime

sleepiness consult clinician

Glod, 1998