Sleeping well 1 by psychologist Sivert Straume presented at RCNUWC Flekke, Sunnfjord, Norway

The presenter Sivert Straume Psychologist Sleep research Clinical work, Aleris medical centre, Bergen Aleris Biggest private health and care enterprice in Scandinavia Sleep school 2

Sleep. Conclusion Sleep is important Follow some sleep advices Don´t worry about your sleep 3

Sleep muscle relaxation altered physiological processes ignoring the surrounding environment altered brain activity an altered state of consciousness 4

Sleep stages 5

Non-REM sleep Stage 1: Light sleep; easily awakened; muscle activity; eye movements slow down. Stage 2: Eye movements stop; slower brain waves, with occasional bursts of rapid brain waves. Stage 3: Considered deep sleep; difficult to awaken; brain waves slow down more, but still have occasional rapid waves. Stage 4: Considered deep sleep; difficult to awaken; extremely slow brain waves. REM sleep Usually first occurs about 90 minutes after you fall asleep; cycles along with the non-REM stages throughout the night. Eyes move rapidly, with eyelids closed. Breathing is more rapid, irregular, and shallow. Heart rate and blood pressure increase. Dreaming occurs. Arm and leg muscles are temporarily paralyzed. 6

Normal sleep 6-9 hours a night? Well-being, good mood, adequate alertness, good health A natural process 7

Insomnia «A condition of unsatisfactory quantity and/or quality of sleep, which persists for a considerable period of time, including difficulty falling asleep, difficulty staying asleep, or early final wakening» (Nonorganic Insomnia in ICD-10) 8

Causes of insomnia Depression Anxiety Somatic disorders and pain Environmental factors Vicious circles of behaviour and cognition 9

Sleep apnea During sleep: Snoring Choking or gasping Long pauses in breathing Daytime sleepiness Waking up with a dry mouth or sore throat Morning headaches 10

Behaviourally induced insufficient sleep syndrome exessive daytime sleepiness short sleep duration considurably longer sleeping in weekends voluntary, but unintentional 11

Pseudo-insomnia Worrying about sleeping to little, while actually sleeping sufficiently. Exaggerated beliefs about sleep need Sleep-state misinterpretation 12

Environmental sleep disorder Lying awake due to the bad sleeping environment Typically sleeping partner´s snoring «Noice in the room, outside the building and in the room next door» 13

Poor sleep, consequences Short-term Sleepiness Fatigue Reduced alertness Bad mood Reduced learning Long-term Depression Anxiety Weight gain High blood pressure Disability 14

Sleep. Conclusion Sleep is important Follow some sleep advices Don´t worry about your sleep 15

Sleep - a natural process Sleepiness factors: Sleep drive Internal clock Wakefulness factors Physiological Emotional Cognitive 16

«Calculating» sleepiness Sleep drive  Internal clock - Physiological arousal - Emotional arousal - Cognitive arousal = Sleepiness 17

Insomnia, vicious circles negative emotions associated with bed and bedtime exaggerated beliefs about the negative consequences of sleep loss dysfunctional compensatory strategies 18

Advices for good sleeping Sleep hygiene Stimulus control Sleep restriction Cognitive therapy Relaxation techniques s 19

Sleep hygiene Sleep as much as possible to feel rested, then get out of bed (do not over- sleep). Maintain a regular sleep schedule. Do not force yourself to sleep. Do not drink caffeinated beverages in the afternoon or evening. Do not drink alcohol prior to going to bed. Do not smoke, especially in the evening. Adjust the bedroom environment to induce sleep. Do not go to bed hungry. Resolve stress and anxiety before going to bed. ExerciseExercise regularly, but not 4-5 hours prior to bed time. 20

Stimulus control Use the bed only for having sex and sleeping, not working, reading, watching TV, eating, or other mentally stimulating activities. Go to bed only when you feel ready to sleep. Turn off the lights and all the noise in and around the bedroom. Get up at the same time every morning to avoid over-sleeping. If you do not fall asleep longer than 20 minutes after going to bed, get up and try some relaxation techniques until you are ready to sleep again. 21

Sleep restriction Careful assesment of sleep pattern with a sleep diary Calculating and planning a new sleep schedule with less time in bed Adjusting sleep schedule to allow gradually more bed-time as sleep efficiency improve 22

Cognitive therapy Unrealistic conceptions about sleep Erroneous conceptions of the sleep problem Erroneous beliefs about the consequences of sleep- loss Misinterpretation of day-time functioning, for instance by interpreting all negative incidences as caused by the sleep-loss. Erroneus beliefs about the causes of sleeplessness 23

Sleep. Conclusion Sleep is important Follow some sleep advices Don´t worry about your sleep 24

Reasons not to worry Biology is on your side. Sleep is important, not crucial. Our body compensates for lost sleep Trancient insomnia is normal. Treatment is available Worrying will not help you 25

How to deal with worrying Distraction (pleasant thought) Mindfulness Constructive problem solving 26

Sleep. Conclusion Sleep is important Follow some sleep advices Don´t worry about your sleep 27

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