Insomnia and poor sleep

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Insomnia and poor sleep




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Presentations text content in Insomnia and poor sleep

Slide1

Insomnia and poor sleep

Dr Phillippa Lawson

Consultant sleep physician

East Anglia

Slide2

About me

Live in Saffron WaldenConsultant in sleep, respiratory and general medicine at West Suffolk HospitalFounder of the good sleep programmeMother to two professors!

Slide3

Outline

What is it?

Who does it affect?

How is it diagnosed?

What can be done?

Slide4

What is insomnia?

Difficulty falling asleep

Difficulty staying asleep

Early morning wakening

Non-refreshing or non-restorative sleep

plus

Daytime symptoms

Prolonged

Slide5

Who does it affect?

Anyone!

Prevalence 10 – 48 % depending on study methods

UK study

§

found incidence to be 15 %, prevalence 37%

More common in females (55 %)

Median age 50 years (18 – 98)

Persistence of insomnia associated with increasing age

Associated with mental health problems

Associated with physical health problems

Associated with other sleep disorders

§

Morphy

et al

SLEEP 30 (3) 2007

Slide6

What causes insomnia?

Predisposing factors

Genetics

Hyperarousal

Depression

Tendency to worry and ruminate

Precipitating factors

Acute stress

Illness (physical or mental)

MedicationsWorry and rumination

Perpetuating factorsDysfunctional attitudes about sleepStaying awake in bedIncreased time in bedWorry and rumination about insomnia

Slide7

Slide8

How do we diagnose it?

Who? Self-diagnose

GP

Specialist in sleep medicine

How? ‘Sleep history’

Questionnaires

Sleep diary

Actigraphy

Polysomnogram

Slide9

Sleep diary example

Slide10

How do we diagnose it?

Who? Self-diagnose

GP

Specialist in sleep medicine

How? ‘Sleep history’

Questionnaires

Sleep diary

Actigraphy

Polysomnogram

Slide11

What can be done?

Set your goals

General wellbeing

Nutrition and fluid intake

Alcohol intake

Caffeine intake

Nicotine

Exercise

Sun light

Incorporating rest times

Positive attitude

Slide12

What can be done?

Preparing the sleep environment

Temperature

Bed and bedding

Light

Calm, uncluttered environment

Clocks and technology!

‘Sleep hygiene’

Regular bed/rise times

Avoiding napping

‘Wind down’ routine

Slide13

What can be done?

Stimulus control

Get out of bed when can’t sleep

Stop all sleep-incompatible activities

Strengthen the bed-sleep association

Sleep restriction

Reduce time in bed to actual sleep

time

Shorten time in bed

Improves sleep efficiency and strengthens bed-sleep association

Avoids disrupted and fragmented sleep

Slide14

Sleep efficiency

Total sleep time

(time from falling asleep to time you woke for final time minus estimated time spent awake during night)

÷

Total time in bed

(time from lights out to time you finally got up)

X 100

Slide15

Sleep diary example

Slide16

What can be done?

Stimulus control

Get out of bed when can’t sleep

Stop all sleep-incompatible activities

Strengthen the bed-sleep association

Sleep restriction

Reduce time in bed to actual sleep time

Improves sleep efficiency and strengthens bed-sleep association

Avoids disrupted and fragmented sleep

Slide17

What can be done?

Relaxation

Progressive muscle relaxation/yoga/Alexander technique

Breathing exercises

Mindfulness

Imagery

Cognitive techniques

Thought blocking

Listing the positives

Turning the tables

Trying to stay awake

Alternative thinking techniques

Carefree attitude towards sleep

Test the hypothesis

Consider cognitive

behavioural

therapy and related techniques

Slide18

Alternative thinking example

Slide19

A carefree attitude towards sleep!

Slide20

What can be done?

Relaxation

Progressive muscle relaxation/yoga/Alexander technique

Breathing exercises

Mindfulness

Imagery

Cognitive techniques

Thought blocking

Listing the positives

Turning the tables

Trying to stay awake

Alternative thinking techniques

Carefree attitude towards sleep

Test the hypothesis

Consider cognitive

behavioural

therapy and related techniques

Slide21

But what about medication?

Many on the market

Frequently employed

Intended as short term aid but often become long term crutch

Daytime side effects

Treating a symptom, not the cause

Perhaps more useful as an ad hoc adjunct, for acute problems

Slide22

Conclusion

Insomnia is not a life sentence

Seeking help is the first step towards moving forward

The ability to succeed comes from within but gaining support will increase your chances of doing so

Positive thinking is key

Believe!

Slide23

"If you think you'll lose, you're lost,

For out in the world we find

Success begins with a fellow's will;

It's all in the state of mind.

Life's battles don't always go

To the strongest or fastest man;

But soon or late the man who wins

Is the man who thinks he can."

Walter D.

Wintle

Slide24

thegoodsleepprogramme

take charge, move forward, live life


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