Juliette Montauk, RN, BSN - PowerPoint Presentation

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Juliette Montauk, RN, BSNGraduate Psychiatric Mental Health Nurse Practitioner MSN Student

An Integrative Approach to Sleep Disorders in Rowan County

Supporting Healthy Sleep Hygiene – Why Clinicians Should Avoid Using Benzodiazepines

Sleep…..What does it mean for our health“For sleep is that golden chain that ties health and our bodies together.”

Thomas Dekker (2003)Digital Image (

n.d

) Retrieved on April 13,

2018 from http://www.tucambioesahora.com/2016/05/asi-me-libere-del-insomnio.html

What is a sleep disorderDifficulty initiating or maintain sleep.15% in the United States have a sleep DisorderHealth OutcomesImpairs functioningImpaired cognitive abilitiesImpaired moodIncrease in chronic illnessesChronic Problem – Sleep Disorder

(Zhou, Gardiner,

Bertisch

,

2017;

Center for Disease

Control (CDC)

, 2014)

Digital

Image (

n.d

) Retrieved on April 13,

2018 from http://thecollaboratory.wikidot.com/general-psychology2-fa11

National sleep statsSignificant insignificant levels of sleep nationwide30-40% in SoutheastNorth Carolina statsApproximately 32% had, on average, poor sleepHighest levels in the more rural communities

Sleep by the Numbers

(CDC, 2014)

Country View (digital image) (2014). Retrieved from

http://file:///C:/Users/jmont/Desktop/UNCCH/primecare/presentation/FS_ShortSleepByState_NC_508tagged.pdf

State View (digital image) (2014). Retrieved from

http://file:///C:/Users/jmont/Desktop/UNCCH/primecare/presentation/FS_ShortSleepByState_NC_508tagged.pdf

Rowan County StatsAverage – 31.7-34.6% Rowan County

What - Serving patients without integrative resources from the communityPharmacologyBenzodiazepines Who - Primary Care Providers

Norm of Current Practice

Digital Image (

n.d.

) Retrieved on April1 13, 2018

from http://genmaspeaks.blogspot.com/2012/09/the-patient-doctor-relationship-in-era.html

Risks of Prescribing Benzodiazepines Digital Image (n.d.) Retrieved on April1 13, 2018 from http://relationshipsreality.com/relationship-risks/

Increase in injuriesRisks of addition

Prescribed more frequently to those at risk

Mortality

Respiratory Distress

Overdose

With opioids

What are the risks?

(

Markota

,

Rummans

,

Bostwick

, &

Lapid

,

2016;

National

Institute on Drug Abuse, 2018

)

American College of Physician & American Academy of Sleep MedicineEffective Sleep HygieneSleep RestrictionCognitive Behavioral Therapy for Insomnia (CBT-I). Mindfulness Current Guidelines

(Morgenthaler, Kramer, Alessi, Friedman, Boehlecke, Brown, et al, 2006;

Qaseem

,

Kansagara

,

Forciea

, Cooke, &

Denberg

, 2016).

Resources for PCPPartnerships in Practice – beyond a referralIntegrative PracticesOne stop shopIntegrative Models of Practice(Zhou, Gardiner, Bertisch, 2017)

Future work - Understanding high levels of sleep disorders in Rural CommunitiesCultural Awareness

Digital image (n.d.) Retrieved April 13, 2018 from https://commons.wikimedia.org/wiki/File:Earnest-broyles-farm-tn1.jpg

Working towards a solution for sleep disordersPharmacology Temporary solution for insomniaCausative factor for other potential harms Integrative Care – The path for future care deliveryConclusion

This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under M01HP31370,

UNC-

PrimeCare

, $1,920,000.00, 100% financed with governmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government

References

Center for Disease Control (CDC). (2014). Sleep and health among adults in North Carolina. Retrieved from http://file:///C:/Users/jmont/Desktop/UNCCH/primecare/presentation/FS_ShortSleepByState_NC_508tagged.pdf

Dekker, T. (1969). The

guls

horne-booke

. Retrieved on April 19, 2018 from http://www.luminarium.org/renascence-editions/dekker2.html

Kroll, D. S.,

Nieva

, H. R.,

Barsky

, A. J., & Linder, J. A. (2016). Benzodiazepines are prescribed more frequently to patients already at risk for benzodiazepine-related adverse events in primary care. 

Journal of General Internal Medicine

, 31(9), 1027-1034. 10.1007/s11606-016-3740-0

Markota

, M., MD,

Rummans

, T. A., MD,

Bostwick

, J. M., MD, &

Lapid

, M. I., MD. (2016). Benzodiazepine use in older adults: Dangers, management, and alternative therapies. 

Mayo Clinic Proceedings

, 91(11), 1632-1639. doi:10.1016/j.mayocp.2016.07.024

Morgenthaler

, T., Kramer, M.,

Alessi

, C., Friedman, L.,

Boehlecke

, B., Brown, T., . . . American Academy of Sleep Medicine. (2006). Practice parameters for the psychological and behavioral treatment of insomnia: An update.

American Academy of Sleep Medicine report

. 29(11), 1415-1419.

10.1093/sleep/29.11.1415

References

Morgenthaler

, T., Kramer, M.,

Alessi

, C., Friedman, L.,

Boehlecke

, B., Brown, T., . . . American Academy of Sleep Medicine. (2006). Practice parameters for the psychological and behavioral treatment of insomnia: An update.

American Academy of Sleep Medicine report

. 29(11), 1415-1419. 10.1093/sleep/29.11.1415

National Institute on Drug Abuse. (2018). Benzodiazepines and opioids. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids

Qaseem

, A.,

Kansagara

, D.,

Forciea

, M., Cooke, M., and

Denberg

, T. (2016). Clinical Guidelines

Comm

Amer

, & for the Clinical Guidelines Committee of the American College of Physicians. Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. 

Annals of Internal Medicine

, 165(2), 125-125. 10.7326/M15-2175

Zhou, E. S., PhD, Gardiner, Paula, MD, MPH, &

Bertisch

, Suzanne M., MD, MPH. (2017). Integrative medicine for insomnia. 

Medical Clinics of North America

, 101(5), 865-865. doi:10.1016/j.mcna.2017.04.005