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Sleep Disturbances- Impact and Intervention
Counselor Toolbox for Mental Health...

 
 
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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