DiscoverCounselor Toolbox PodcastSleep Disturbances- Impact and Intervention
Sleep Disturbances- Impact and Intervention

Sleep Disturbances- Impact and Intervention

Update: 2019-11-23
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443 – Sleep Disturbances:

Impact and Intervention

Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs

Podcast Host: Counselor Toolbox & NCMHCE Exam Review


Objectives

• Learn about sleep

• The function of sleep

• Sleep cycles

• How much is enough

• How lack of sleep contributes to feelings of depression, anxiety and irritability

• Understand the connection between sleep and circadian rhythms

• Learn techniques for sleep hygiene


Impact of Sleep Disturbance

• People whose circadian rhythms are off

• Have a difficult time getting restful sleep

• Usually have higher cortisol levels

• Often report being tired at all the wrong times

• Have difficulty concentrating

• Confuse sleep and hunger cues

What is the Function of Sleep

• Sleep is time to rest and restore

• Adequate sleep improves memory and learning, increases attention and creativity, and aids in concentration and decision making.

• Toxins that accumulate in the brain are thought to be cleared out during sleep

• Healing and repair of cells takes place during sleep

• Sleep helps to maintain the balance of hormones in the body:

• Ghrelin and leptin, which regulate feelings of hunger and fullness

• Insulin, which is responsible for the regulation of glucose in the blood


Functions cont…

• Sleep deficiency is also linked to a higher risk of

• Cardiovascular disease

• Stroke

• Diabetes

• Kidney disease

• Sleep deprivation is correlated to

• Difficulty concentrating

• Irritability

• Fatigue/Loss of energy


Understanding Sleep Cycles

• Stage 1 NREM sleep is when you drift in and out of light sleep and can easily be awakened.

• Stage 2 NREM brainwaves slow with intermittent bursts of rapid brain waves, the eyes stop moving, the body temperature drops and the heart rate begins to slow down. 

• This stage usually lasts for approximately 20 minutes

• Stage 3 NREM sleep, also known as deep sleep or delta sleep, is marked by very slow delta brainwaves. There is no voluntary movement. You are very difficult to wake.

• This stage usually lasts for approximately 30 minutes

• The largest percentage of Deep Sleep comes in the early part of the total night's sleep pattern

Understanding Sleep Cycles

• REM Sleep (Rapid Eye Movement) is characterized by temporary paralysis of the voluntary muscles and fast, irregular breathing, inability to regulate body temperature, faster brain waves resembling the activity of a person that is awake.

• Most dreams occur during REM sleep


How Much is Enough?

Sleep and Hormones

• Estrogen usually improves the quality of sleep, reduces time to fall asleep, and increases the amount of REM sleep

• Too little or too much testosterone may affect overall sleep quality

• Cortisol is your stress hormone and prevents restful sleep

• Thyroid hormones which are too high can cause insomnia and too low can cause fatigue and lethargy


Nutrition and Sleep

• Tryptophan is used to make serotonin

• Serotonin is used to make melatonin

• Melatonin functions to help you feel sleepy

• Caffeine is a stimulant with a 6-hour half life

• Nicotine is a stimulant with a 2-hour half life

• Decongestants are stimulants with a 2-hour half life

• Antihistamines make you drowsy but contribute to poor quality sleep

• Alcohol blocks REM sleep and can cause sleep apnea

Nutrition cont…

• Eat a high protein dinner to ensure you have enough tryptophan in the body

• Make sure you are getting enough

• Selenium

• Vitamin D

• Calcium

• Vitamin A

• Magnesium

• Zinc


Function of Sleep

• Allows the brain to focus on rebuilding and repairing

• Animals deprived entirely of sleep lose all immune function and die in just a matter of weeks.

• Prisoners deprived of sleep entirely often develop psychotic symptoms

• New parents deprived of sleep have difficulty with memory and concentration

• Muscle growth, tissue repair, protein synthesis, and growth hormone release occur mostly, or in some cases only, during sleep.

• Other rejuvenating aspects of sleep are specific to the brain and cognitive function.

• While we are awake, neurons in the brain produce adenosine.

• The build-up of adenosine in the brain may lead to our perception of being tired.


Circadian Rhythms

• Internal Body Clock

• patterns of brain wave activity, hormone production, cell regeneration, and other biological activities linked to this 24-hour cycle.

• normal circadian clock is set by the light-dark cycle over 24 hours.

• Circadian rhythms allow organisms to anticipate and prepare for precise and regular environmental changes. They thus enable organisms to best capitalize on environmental resources (e.g. light and food)

Circadian Rhythms

• Circadian rhythm disorders can be caused by many factors, including:

• Shift work

• Pregnancy

• Time zone changes

• Medications

• Changes in routine such as staying up late or sleeping in

• Medical problems including Alzheimer's or Parkinson disease

• Mental health problems


Impact of too much/too little sleep

• Explore the effects of:

• Insufficient sleep

• Energy Allocation

• Disrupts normal hormonal rhythms

• Excessive sleep

• Disrupts normal hormonal rhythms

• Can make you sleepier due to lack of movement and light.


Serotonin Connection

• Serotonin and sleep

• L-Tryptophan is used to make serotonin

• Serotonin is used to make melatonin

• When serotonin and/or melatonin levels rise, other hormones like norepinephrine go down

• Depression & Anxiety

• Too much or too little serotonin impacts mood

• Symptoms of depression and sleep deprivation are very similar: Altered feeding and sleeping habits, fatigue, difficulty concentrating


Sleep Hurdles

• Drugs

• Stimulants (caffeine, pseudoephedrine, diet pills, preworkout supplements, nicotine, ADHD medications)

• Sedatives (Anti-anxiety medications, barbiturates)

• Diphenhydramine (Benadryl ®)

• Pain medications (Opiates)

• Alcohol


Sleep Hurdles

• Physical Conditions

• Pain

• Pregnancy / PMS / Postpartum

• Temperature regulation

• Changes in estrogen levels impact serotonin levels

• General discomfort

• Apnea

• Allergies

• Sinus congestion

• Coughing

• Restless leg syndrome

• Head Injury especially to the front part of the brain


Sleep Hurdles cont…

• Hormones

• Stress hormones (Cortisol, Thyroxine)

• High levels of cortisol can create agitation, insomnia and sugar cravings.

• Low levels can be associated with inability to handle stress, extreme fatigue, low libido and mood instability.

• Estrogen

• Increases norepinephrine and serotonin

• Decreases dopamine

• Testosterone

• Progesterone: balance estrogen, promote sleep and has a natural calming effect. Abnormal levels of progesterone cause insomnia and contribute to irritability.

Sleep Hurdles cont…

• Light levels

• As light increases, so do our motivating chemicals (norepinephrine)

• As light decreases the body secretes serotonin that is converted to melatonin

• Physical cues

• Alarm clock

• Eating meals

• Coming home from work

• Certain routines


Sleep Hurdles cont…

• Lack of Exercise

• Exercise helps reduce cortisol levels

• Increases serotonin levels

• Can help in reducing aches and pains which keep people awake

• “Stress”

• Racing thoughts

• Ruminations

• High levels of “fight or flight” (excitatory) hormones


Sleep Hygiene

• Create a wind-down ritual

• Reduce or eliminate exposure to blue-light 1 hour before bed (TV, Computer, Phone, some light bulbs)

• Go to bed at roughly the same time every night

• Eliminate as much light as possible (Sleep mask)

• Eliminate as much noise as possible (Ear plugs)

• Do not exercise or take a hot bath within 2 hours of bed.

• Keep the room cool (72 is ideal)

• Consider a cooling pillow and mattress topper

• Avoid anything that might get you upset (Social media)


Sleep Hygiene

• Reduce or eliminate caffeine at least 6 (preferably 12) hours before bed

• Drink the majority of fluids during the day

• Keep an air purifier in the room if you have allergies

• Keep animals off the bed

• Make the bedroom a place of relaxation and sleep

• Keep a red-light and a notepad by your bed to write down anything that pops into your head

• Weighted blankets help some people get to sleep easier


Sleep Hygiene

• Keep daytime naps to under 45 minutes

• Consider diffusing essential oils

• Lavender

• Chamomile

• Patchouli

• Catnip (Yep…catnip…just don’t let the cats in the bedroom)

• Select the right pillow


Summary

• Insufficient quality sleep contributes to

• Fatigue

• Difficulty concentrating

• Reduced reaction time

• Apathy

• During deep sleep is when researchers think the brain rests and rebalances.

• Over time sleep deprivation can cause changes in

• Neurotransmitter levels

• Immune functioning

Summary cont…

• Most people could benefit from auditing their sleep quality

• Reduce light

• Reduce noises

• Reduce bathroom trips

• Reduce wake-ups because of allergies or being too hot

• Stop caffeine 6 (preferably 12) hours before bed

• If you are only willing to change one thing this month to start being happier, more energetic and clearer headed, sleep might be a great place to start.

Additional Resources

• http://www.news-medical.net/health/Function-of-Sleep.aspx

• http://staging.aesnet.org/files/dmfile/Saper1.pdf

• http://www.sleepdex.org/stages.htm

• http://psychcentral.com/lib/stages-of-sleep/

• https://sleepfoundation.org/how-sleep-works/what-happens-when-you-sleep

• http://www.ncbi.nlm.nih.gov/books/NBK10996/

• https://www.drmarinajohnson.com/articles/chronic-insomnia-and-hormones/

• The Relationship Between Testosterone and Sleep Disorders https://www.ncbi.nlm.nih.gov/pubmed/24435056

• https://www.bcm.edu/news/sleep-disorders/experts-warn-against-antihistmaines-sleep-aid

• https://sleepfoundation.org/sleep-topics/how-alcohol-affects-sleep

• http://www.webmd.com/sleep-disorders/news/20130118/alcohol-sleep#1

• The Effect of Melatonin, Magnesium and Zinc on Insomnia https://www.ncbi.nlm.nih.gov/pubmed/21226679

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Sleep Disturbances- Impact and Intervention

Sleep Disturbances- Impact and Intervention

Charles Snipes