1. Sleep Hygiene Phyllis M.Connolly, PhD, RN, CS

2. 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

3. Characteristics Primary Sleep Disorders

4. 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

5. 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

6. Substance-Induced Sleep Disorder Antidepressants Antihypertensives Antihistamines Corticosteroids Stimulatants Sedative-hypnotics Cholinergic agents Cold preparations Alcohol Caffeine Opiods Amphtemines

7. Methods of Evaluating Sleep Disorders Sleep Diaries History, Physical Exam, Detailed Sleep Disorders Assessment Polysomnography (PSG) Multiple sleep Latency Test (MSLT) Actigraphy Glod, 1998

8. 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

9. 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

10. 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