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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.

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Presentation on theme: "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."— Presentation transcript:

1 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

2 Behavioral 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. 2

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4 Sleep Requirements 12 TO 18 YEARS OLD: 8½ – 9½ HRS/NIGHT ADULTS (18+): 7½ - 8 HRS/NIGHT 4

5 Signs 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. 5

6 Effects 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 6

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8 Sleep Disorders INSOMNIA SLEEP APNEA CIRCADIAN RHYTHM DISORDERS 8

9 Insomnia  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 9

10 Sleep 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 10

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12 Circadian 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 12

13 Sleep Hygiene TIME TO REBOOT LOL...OMG...IDK: WHY AM I SO TIRED? 13

14 What 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. 14

15 General 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 15

16 Ways 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. 16

17 Ways for Students to Have Better Sleep in Job Corps  Eye mask to help make room dark.  Log off instant messenger, Facebook, and .  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. 17

18 Consequences 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. 18

19 Cognitive Behavioral Strategies 19

20 Cognitive 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. 20

21 Strategies  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. 21

22 Strategies  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. 22

23 Sleep 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 23

24 Pharmacotherapy for Sleep Disorders HERBAL/NATURAL SLEEP AIDS OVER-THE-COUNTER SLEEP AIDS PRESCRIPTION DRUGS 24

25 Principles  Try non-pharmacological approaches first – lifestyle modification, environment, exercise.  Sleep medications are for short-term use only. 25

26 Herbal/Natural Sleep Aids  Melatonin - naturally occurring hormone that increases at night triggered by darkness – 1 mg to 3 mg taken 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 26

27 Over-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 27

28 Prescription 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)] 28

29 Prescription 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 29

30 Resources  Sleep Hygiene Student Brochure  Health Care Guidelines for Sleep Hygiene—Coming soon!  Apps  White Noise  Breathing Exercise  Progressive Relaxation  Mindfulness Strategies  Sleep Diary/Journal 30

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