Sleep shedule and hygiene ppt ppt pp.pdf

It is related to mental health

1. Sleep Schedule & Sleep Hygiene
Healthy Sleep Healthy Mind
Presented by
Chowdhury MehtajJabeenMedha
Intern Clinical Psychologist
Mental Hospital Pabna
Department of Clinical Psychology
University of Rajshahi

2. Content
1.Sleep
2.Sleep cycle
3.Sleep Disturbances
4.Causes of Sleep Disturbances
5.Sleep Hygiene
6.Sleep Schedule
7.Cognitive Approch

3. Sleep
Sleepisasedentarystateofmind
anditischaracterizedbyaltered
consciousness,relativelyinhibited
sensoryactivity,reducedmuscle
activityandreducedinteractions
withsurrounding.
Sleepcanbeobjectivelystudiedby
using polysomnography a
technique combining the
measurementofbrainactivity
(electroencephalographyorEEG),
eye movements (electro-
occulography),andmuscletone
(electromyography).

4. Sleep cont…
Polysomnography,alsocalledasleepstudy,isa
comprehensivetestusedtodiagnosesleepdisorders.
Polysomnographyrecordsyourbrainwaves,theoxygen
levelinyourblood,heartrateandbreathing,aswellaseye
andlegmovementsduringthestudy.

5. Sleep cont…
NREM
(Non-rapid-eye-
movement)
REM
(Rapid-eye-
movement)
Stage 1 Stage 2 Stage 3 Stage 4

6. 5-10 min
20 min
20-40 min
Stage 1 Stage 2 Stage 3 & 4 REM

8. Sleep cont…
Inhealthyyoungadultswhofollowaregularsleepschedule,
theproportionoftimespentinREMsleepisabout25%,
whiletheremaining75%isspentinNREMsleep.NREM
Stage1representsabout5%,Stage2another50%,andStages
3-4about20.9%.

10. Insomnia
Insomniaisacommon
sleepdisorderthatcan
makeithardtofall
asleep,hardtostay
asleep,orcauseoneto
wakeuptooearlyand
notbeabletogetback
tosleep.

11. Insomniacont…
AccordingtoDSM-5,diagnosticcriteriaofinsomnia
A.Apredominantcomplaintofdissatisfactionwithsleep
quantityorquality,
associatedwithone(ormore)ofthefollowingsymptoms:
1.Difficulty(initiatingsleep.Inchildren,thismaymanifestas
difficultyreturningsleepwithoutcaregiverintervention.)

12. Insomnia cont…
2.Difficultymaintainingsleep,characterizedbyfrequent
awakeningsorproblemsreturningtosleepalterawakenings.
(Inchildren,thismaymanifestasdifficultyreturningtosleep
withoutcaregiverintervention.)
3.Early-morningawakeningwithinabilitytoreturntosleep.

13. Insomnia cont…
B.Thesleepdisturbance(orassociateddaytimefatigue)
causesclinicallysignificantdistressorimpairmentinsocial,
occupational,orotherimportantareasoffunctioning.
C.Thesleepdifficultyoccursatleast3nightsperweek.
D.Thesleepdifficultyispresentforatleast3months.
E.Thesleepdifficultyoccursdespiteadeuateopportunityfor
sleep.

15. .
Primary and secondary Insomnia
Inprimaryinsomnia,thesleep
disturbancedoesnotoccurexclusivelyin
thecontextofanothermedical,
psychiatric,orsubstanceabusedisorders.
Insecondaryinsomnia,thesleep
disturbanceisetiologicallylinkedtoan
underlying condition, including
psychiatric,medical,substanceabuse,and
othersleepdisorders.

16. Insomnia cont…
According to duration of
time,
Episodic:Symptomslast
atleast1monthbutless
than3months.
Persistent:Symptoms
last3monthsorlonger.
Recurrent:Two(or
more)episodeswithin
thespaceof1year.

17. Causes of Insomnia
Stress:Stressfullifeevents
ontrauma-suchasthe
deathorillnessofaloved
one,divorce,orajobloss
alsomayleadtoinsomnia.
Travelorworkschedule:
Causesincludejetlagfrom
travelingacrossmultiple
timezones,workingalate
orearlyshift,orfrequently
changingshifts.

18. Causes of Insomnia cont…
Poorsleephabits:Poorsleep
habitsincludeanirregular
bedtime schedule,naps,
stimulatingactivitiesbefore
bed,anuncomfortablesleep
environment,andusingyour
bedforwork,eatingorwatching
TV.Computers,TVs,video
games,smartphonesorother
screensjustbeforebedcan
interferewithyoursleepcycle.

19. Causes of Insomnia cont…
Eating too much late in the
evening
Having a light snack before
bedtimeis OK,
Buteatingtoomuchmay
causeyoutofeelphysically
uncomfortablewhilelying
down.
Manypeoplealsoexpericnce
heartburn,abackflowofacid
andfoodfromthestomach
intotheesophagusafter
eating,whichmaykeepyou
awake.

20. Causes of Insomnia cont…
Additional common causes of insomnia include:
Mentalhealthdisorders.
Anxietydisorders:Patientscan’tsleepproperly.Difficulty
fallingorstayingasleeporrestless,unsatisfyingsleep.
Post-traumaticstressdisorder:Difficultyfallingorstaying
asleeporrestless,unsatisfyingsleep.
Depression:Awakeningtooearlycanbeasignofdepression.
may disrupt your sleep.
insomnia often occurs with other mental health disorders as
well.

21. Causes of Insomnia cont…
Medications:
Many prescription
drugscaninterferewith
sleep,suchascertain
antidepressantsand
medicationsforasthma
orbloodpressure. The-countermedications
suchassomepain
medications,allergyand
coldmedications,and
weight-lossproducts-
containcaffeineandother
stimulantsthatcandisrupt
sleep.

22. Causes of Insomnia cont…
MedicalConditions:Examplesofconditions
linkedwithinsomniaincludeçhronicpain,cancer,
diabetes,heart._disease,asthma,gastroesophageal
refluxdisease(GERD),overactivethyroid,
Parkinson'sdiseaseanAlzheimer'sdisease.

23. Causes of Insomnia cont…
Sleeprelateddisorders:Sleepapneacausesyoutostop
breathingperiodicallythroughoutthenight,interrupting
yoursleep.
Restless legs syndromecauses unpleasant sensations in your
legs and an almost irresistible desire to movethem, which
may prevent you from falling asleep.

24. Causes of Insomnia cont…
Caffeine,nicotineand
alcohol:Coffee,tea,colaand
othercaffeinateddrinksare
stimulants.
Drinkingtheminthelate
afternoonoreveningcankeep
youfromfallingasleepat
night.
Nicotineisanotherstimulant
thatcaninterferewithsleep.
Alcoholmayhelpyoufall
asleep,butitpreventsdeepo
stagesofsleepandoften
causesawakeninginthe
middleofthenight.

25. Risk Factors
1
•You're a woman.
2
•You’re over age 60
3
•You’re have a mental health disorder or
•physical health disorder
4
•You’re under a lot of stress
5
•You don’t have a regular schedule

26. Hypersomnia
Theword“hypersomnia”
isderivedfrom“hyper”
(toomuch)and“somnia”
(sleep)
Hypersomniaisthe
inabilitytostayawake
andalertduringtheday
despitehavingmore
thananadequate
amountofnighttime
sleep.

27. Hypersomnolence
Itisaconditionwherea
personexperincessignificant
episodesofsleepiness,even
afterhaving7hourseormore
ofqualitysleep.(Timothy
J.Legg,PhD)
Narcolepsy and hypersomnia
are considered “central
disorders of
hypersomnolence.”

28. Signs and symptoms of hypersomnia
Constant, recurrent episodes of extreme sleepiness during
the day.
Sleeping longer than average (10 or more hours) yet still
being very sleepy during the day and having difficulty
remaining awake during the day.
Difficulty waking up in the morning (“sleep drunkenness”)
or after daytime naps, sometimes appearing confused or
combative.
Daytime naps don’t lead to improved alertness. They are
unrefreshing.

29. Causes of Hypersomnia
The sleep disordersnarcolepsy(daytime sleepiness)
andsleep apnea(interruptions of breathing during
sleep)
Not getting enough sleep at night
Being overweight
Drug or alcohol abuse

30. Causes of Hypersomnia cont…
Ahead injuryor a neurological disease, such as
multiple sclerosis or Parkinson's disease
Prescription drugs
Genetics (having a relative with hypersomnia)
Depression

31. Narcolepsy
Narcolepsyisasleepdisorder
thatcausesapersontofeel
overlysleepyortofallasleep
atunwantedtimesduring
theday.thepersonmustfeel
excessivelysleepyorhavean
overwhelmingneedtosleep
duringthedayforthreeor
moremonths.Thisneedfor
sleepmayresultin“sleep
attacks,”inwhichaperson
suddenlyfallsasleepwhile
engaginginanactivitylike
walkingoreating.

32. Who is he?

33. Parasomnia
Anabnormaldisruptionof
sleep,suchassleepwalking,
sleeptalking,nightmares,
bedwetting,sleepapnea
(problemswithbreathingthat
causeloudsnoring),or
nighttimeseizures.
AsdefinedinDSM-5,this
includesrepetitive,extended,
extremelydysphonic,andwell-
recalleddreamsthatinvolve
threatstosurvival,security,or
physicalintegrity;episodes
usuallyoccurduringthesecond
halfofthesleepperiod.

34. Sleep Apnea
AccordingtoDSM5,Apneaor
hypopneainadultsisdefined
asbreathingdisturbancesof
atleast10secondsortwo
missedbreathsinchildren.
Thesebreathingdisturbances
aremostoftenmarkedby
snoringand daytime
sleepiness.
In clinically definition, Sleep
apnea isa potentially
serious sleep disorder in
which breathing repeatedly
stops and starts. If you snore
loudly and feel tired even
after a full night's sleep, you
might have sleep apnea.

35. Sleep Hygiene
The term “sleep hygiene”
was first used by Dr. Peter
Hauri.
Sleep hygiene refers to
things about lifestyle and
preparation for bed that
can be changed to
improve seep pattern.

36. Seep Hygiene Checker
Good
Sleep
hygiene
Limit
caffeine
Manage
exercise
Manage
diet
Limit
alcohol
Limit
nicotine
Limit
noise
Room
temperature
Manage
Body
temperature
Improve
air quality
Limit light
Improve
bed
comfort
Life Style Factor
Bedroom Factor

37. Sleep Hygiene cont…
Caffeine
weshouldexplain,caffeine
isapowerful,andreadily
available,stimulantdrug.
Weshouldexplaintoour
patientsthatto0much
caffeinecouldbeverygood
atkeepingthemawake!
Cocoa,chocolatebars,
carbonateddrinks(cola,
sodas),energydrinksand
weightcontrolmedicines
maycontaincaffeine.
wesuggestthatpatients
shouldonlyhavede-
caffeinateddrinksforupto
4hoursbeforebedtime.

38. Sleep Hygiene cont…
Alcohol
Thenightcapthatdoesn't
reallyfit.Alcohol,unlike
caffeineandnicotine,may
helpyourpatienttofall
asleepatthebeginningof
thenight.
Itactslikeahypnoticdrug
thatoccurscausinglighter
sleepandarousals.
Alcoholalsocontributes
toward dehydration.
Patientsmayaeakeup
thirstyandmayneedto
urinate.
So,Weshouldadviseour
patientsthatIcannot
reallysupporttheideaofa
'nightcap'! We
Recommendthatalcohol
shouldbeavoidedfrom4
hourspriortobedtime.

39. Sleep Hygiene cont…
Nicotine
Smokingdamagesyour
health;itmayalsodamage
yoursleep.
Exercise
Tiringyourselfoutat
bedtimeisabadidea,
especiallyifyouareunfit

40. Sleep Hygiene cont…
Diet
Don'tgotobedonan
emptystomach.Hunger
cancausewakefulness.
Thatiswhyalightsnacka
littlebeforecanaidsleep.
Goingtobedtoofullcan
causewakefulness.We
shouldExplaintoour
patientthatsleepisavery
activeprocess.Thisactivity
includesthe body’s
metabolism.
Patientsshouldeatonlya
smallamount,whenthey
wakeupinthenigh.

41. Sleep Hygiene cont…
Dieting to lose weight
can also effect upon
sleep. In particular,
weight
Loss occurring too
quickly may lead to
broken sleep. You will
also recall that
Heavier people are more
likely to snore which can
disrupt sleep.
We also mentioned
earlier the important of
patients remaining
hydrated. Water is good.

42. Sleep Hygiene cont…
Temperature
Ahotroom(morethan
24°C)cancauserestless
bodymovementsduring
sleep,morenighttime
wakening,andless
dreamtypesleep.
Acoldroom(lessthan
12°C)canmakeit
difficulttogettosleep
andcancausemore
unpleasant and
emotionaldreams.
We recommend room
temperature to help
promote sleep for most
people is, therefore,
around 18°C.

43. Sleep Hygiene cont…
Lighting
bright white light, can cause
wakefulness
the bedroom should not be too
bright
acombination of strong street
lighting and thin curtains
should be avoided.
Asolution may be to cover
windows with thick curtains,
blinds or even a blanket.
Sleep with blinders

44. Sleep Hygiene cont…
Rationale for relaxation
therapy
Breathing Relaxation
PMR
Mindfulness training
Sounds familiar
Air quality
Mattress and pillows

45. Restrict your time spent in bed
Establish your threshold time for Bed
Establish your rising time
Go to bed only when you feel sleepy
Follow a 7-night-per-week schedule
Observe the 15 minute rule
Make adjustments to your new schedule
Make the connection between bed and sleep
Avoid day time naps

46. (1)Restrict Your Time Spent in Bed
For example, a person may sleep three or four hours some
nights, while other nights manage to get seven.
Itishardtoknowforourpatienthowmuchsleepthey
needrightnow.
KeepaSleepDiaryandworkoutanaverage.

47. Askingthemtopatienttokeeparecordoftheirsleepfora
coupleofweeks.
10-nightperiodtoworkoutmustbedividedby10.Thenwe
willgetaveragetime.
Thattimeisrestrictiontimeforspendinginbed.

48. 2. Establish Your Rising Time
Your next goal is to help your patient achieve this same
amount of sleep each night.
An effective way of achieving this is to "anchor' sleep.
sleep as much as you can at the same time every day five
hours or more, Scientists call thisregular sleep period
anchor sleep.
Encourage your patient to think of a time to rise each and
every morning, including weekends.

49. 3. Establish Your Threshold Time for Bed
Here is an example,
Average sleep time: 6 hours
Set rising time: 7 a.m.
Threshold time: 7 a.m. –6 hours = 1 a.m.

50. 4. Go to Bed Only When
You Feel Sleepy
They should go to bed when
they think theyfeel sleepy
enough to sleep through the
night.
If they are not "sleepy tired‘,
then they break the connection
between bed and sleep.

51. To recognize signs such As itchy eyes, lack of energy aching
muscles yawning.
Help them also to differentiate tiredness from sleepiness
Importantly, remind your patients that they should notgo
to bed until they are sleepy after their threshold time.

52. 5. Follow a7-Night-per-Week Schedule
By following the new schedule every single night you will
establish a strongpattern for the future.
This is one of the simplest but also one of the hardest
instructions.
Patient should maintain new schedule of threshold time and
rising time at the 7-night per week.
The goal is to establish a strong sleep drive and adurable good
sleep habit

53. 6. Observe the 15-Minute Rule
You should advise that if sleep does not come within15
minutes, they should get out of bed and go into another room.
They should go back to bed when feeling sleepy again, but if
still unableto sleep, should wait no longer than 15 minutes
before getting up once again.
Thissame rule should be applied if your patient has the
problem of waking up duringthe night and has difficulty
returning to sleep.

54. 7. Making Adjustments to Your New Schedule
time inbed can be increased by 15 minutes per night for one
week by going to bed15 minutes earlier
Patient can increase their threshold time for next week.
Calendar ticking.

55. 8. Make The Connection Between Bed and Sleep
Our goal is to encourage patients to use their bed only
for sleep, so that they build a strong link between bed
and sleep.
Activities like watching TV, reading, eating and talking
on the phone are to be kept for other rooms in the
house and banned from the bed room.
Bed should be used only for sleep and sexual activities.

56. 9. Avoid Daytime Naps
We should explain that the connection between nighttime
sleep and the bed is to avoid napping during the day and
napping in the evening.
There is evidence that a nap of more than 15 minutes reduces
the drive for sleep at night.

57. Thought Blocking
Here are the instructions to topatients
1.While lying in bed with your eyes closed.
2.Repeat the word ‘the’ once or twice every second in your
head.
3.Don’t say it out loud, but it may help if you ‘mouth it’.
4.Keep up these repetition for about 5 minutes or until
sleep ensues.