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Sleep Hygiene (Evidence base (:green_cross:Staner, 2010
Suggests 3 out of…
Sleep Hygiene
Evidence base
:green_cross:Staner, 2010
Suggests 3 out of 4 people with depression experience sleep difficulties
:green_cross:Franzen & Buysse, 2008
Insomnia increases the risk of relapse in depression
:green_cross:Espie, 2002
Prevalence of chronic insomnia is 9-12% in adulthood and more in later life
:green_cross:Espie, 2002
Women are x2 more likely to experience sleep difficulties
:warning:Bennett-Levy et al, 2001
Adherence to SH recommendations is lower in people with insomnia compared with general population
:check:Bennett-Levy et al, 2001
LI interventions using books and brief phone contact lead to clinically significant improvements in 50-86% of individuals
:green_cross:Morin et al, 1999
CBT with or without pharmacotherapy compares favourably to pharmacotherapy alone in older adults
:check:Vincent, 2003
RCT showed the provision of normative information on sleep patterns reduced anxiety about sleep and increased adherence to work on sleep
:warning:Bennett-Levy et al, 2001
Found by week 5 of cCBT, homework adherence dropped to 50%
:green_cross:Bixler et al, 1984
Takes around 20-30mins to fall asleep and people wake 3-4 times per night
Challenges/Solutions :!?: (Westbrook et al, 2011)
- No progress
Check of proper implementation
Be patient
- Lack of motivation/engagement
- Techniques used may become safety behaviours
Warn against this and monitor
- Patients think they have tried everything
Empahise, discuss why attempts in the past have not worked, ask them to try with you
- Undisclosed drug use
Stimulants limit chance of success
- Sleep issues due to a secondary problem (psychiatric/physical)
Consider referral to specialist
Mental health and sleep
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PTSD can cause nightmares/night terrors that disturb sleep. Can lead to feeling anxious about falling asleep> insomnia
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Medication can cause side effects including insomnia, oversleeping, disturbed sleep. Stopping medication can also cause this.
WHAT (Papworth et al, 2013)
Environmental (life events), physical issues, thinking styles and behavioural decisions contribute to healthy sleep habits that precede and prepare one for a quality night of sleep i.e lifestyle and bedtime routine (Espie, 2006)
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WHEN (Westbrook et al, 2011)
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Should not be used for sleep disorders such as narcolepsy, sleep apnoea, substance induced problems
Common Sleep difficulties (Richards & Whyte, 2011)
- Getting to sleep
- Staying asleep
- Waking too early
- Disturbed sleep
- Unrefreshing sleep
- Worries about sleep
- Oversleeping
Protocol :!:
- Understand the sleep problem (baseline diary, specific nature
- Give psycho-education (maintenance cycle, typical sleep and hygiene)
- Plan an approach (SH techniques, other techniques)
- Deliver
- Review
Richards & Whyte, 2011
Understanding the problem:
- Is sleep the main/sole problem?
- Sleep contributing to depression/anxiety
- Check contributing factors (pain, emotional difficulties, bereavement, meds, bladder issues, substance use, environmental factors)
- Issues with daily activities?
- Patient symptoms, patterns, goals
- Treatment history
Sleep Hygiene - Avoid
- Bright lights (inhibits production of melatonin)
- Regular/repeated naps
- Stimulants (caffeine, alcohol)
- Eating/exercising 3 hours before
- Emotional conversation/activity
- Intrusive/Worrying thoughts (use a notepad)
Sleep Hygiene - Include
- Create bed time routine
- Create comfortable sleeping environment
- Eat healthy diet
- Classic conditioning (bed only for sleep and sex)
- Maintain natural rhythm (circadian rhythm)
- Practice deep breathing
- PGMR
- Practice relaxation/visualisation
Circadian Rhythms
- The bodies natural internal clock that keeps sleep wake cycle
- Melatonin cycle is part of the hormonal package (Circadian rhythm)
- A regular schedule from sunrise to sunset is the best way to regulate your circadian rhythm
Effects of poor sleep
- Excessive daytime sleepiness/fatigue
- Poor memory and concentration
- Mood changes, irritability
- Weakened immune system
- Weight gain
- Impaired judgement, increased impulsivity
- Intrusive negative thoughts
Sleep Cycle
- Non REM sleep consists of 4 stages, each deeper than the last
- REM sleep when you do most active dreaming
- Transition to sleep, eyes move under eyelids, muscle activity slows, easily awakened
- Light sleep, eye movement stops, heart rate slows, body temp drops
- Deep sleep, difficult to wake, if woke difficult to adjust and groggy/disorientated
- Intense deep sleep, brain waves extremely slow, blood flow directed away from brain towards muscles restoring physical energy
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