Sleep

REM Sleep

active sleep

25% of the night

90 min cycles

immobile bodies

irregular breathing and heart rate

Non-REM Sleep

quiet sleep

stages 1-3

70% of the night

tissue growth and repair occur

Non-REM Sleep: Stage 1

changeover from wakefulness to sleep

Non-REM Sleep: Stage 2

period of light sleep before you enter deep sleep

Non-REM Sleep: Stage 3

period of deep sleep that you need to feel refreshed in the morning

C Process (Circadian Rhythm)

sleep wake cycle

are internally driven cycle that his and fall during the 24 hour day

help you fall asleep at hight and wake you up in the morning

schedule of when a person is asleep or awake during a 24 hour period

unique and dynamic cycles

can be affected by: age, genetics, lifestyle factors

Homeostatic S Process: Sleep Pressure

our need for sleep

sleep pressure build up in our body as awake time increases

may be set back with naps

may be increased with cognitively and/or physically demanding activities

Social Jet Lag

differnece in sleep between weekdays and weekends (free days)

Catch Up Sleep

sleeping more to “catch up” on previously lost sleep

Circadian Rhythm as We Age

pineal gland produces melatonin

pineal glad calcifies as we age (which is associated with numerous diseases

Melatonin

hormone responsible for regulating our circadian rhythm

Sleep Deprivation Consequences

high blood pressure

diabetes

heart attack

heart failure/stroke

increased fall risk

impaired cognitive functioning (increasingly correlated with dementia)

Sleep Complaints

sleep fragmentation

abnormal sleep duration

trouble falling or remaining asleep

difficulty staying awake during the day

sleep-wake cycle imbalances that interfere with a healthy sleep schedule

Insomnia

difficulty falling and/or staying asleep

mot common sleep problem in adults age 60 and older

Nighttime Urination (Nocturia)

waking to use the bathroom

it can be common for people to wake up once during the night, but peeing more frequently may be a sign of an underlying condition or problem

talk with your doctor

stop drink fluids 2-3 hours before sleep

Daytime Drowsiness (Flipped Day and Night)

medications, lack of stimulating activities might be possible contributors to this condition

some diagnoses (ex: dementia) might mean that people are susceptible to “flipped” sleep/wake cycles: falling asleep during the day and being awake and active at night

Pain

can cause someone to have disrupted sleep

Sleep Apnea

breathing repeatedly stops and starts during sleep

obstructive, central, treatment emergent

Obstructive Sleep Apnea (OSA)

occurs when throat muscles relax and block the flow of air into the lungs

Central Sleep Apnea (CSA)

occurs when the brain does not send proper signals to the muscles that control breathing

Treatment Emergent Centra Sleep Apnea (Complex Sleep Apnea)

when someone has OSA (diagnosed with a sleep study) that converts CSA when receiving therapy for OSA

Restless Leg Syndrome (RLS)

condition where there is an irresistible urge to move the legs

Parasomnia

abnormal experiences or behaviors during sleep

non-REM, REM, other

Non-REM Parasomnia

sleep terrorrs

sleep walking

confusion

arousal

REM Parasomnia

nightmare disorders

REM sleep behavior disorder

sleep paralysis

REM Sleep Behavior Disorder (RBD)

parasomnia during REM phase where the person acs out their dreams

Other Parasomnia

bedwetting

sleep groaning

hallucination

DIMS

disorder of initiating and maintaining sleep

fatigue

DOES

disorders of excessive somnolence

sleepiness

Preparation

establishing activity patterns that promote sleep and health

Participation

sustaining a sleep state without disruption

Naps

cultural meaning and significance

can reduce fatigue, increase alertness, relaxation and improve mood

drawbacks: sleep inertia and impact on night time sleep

keep them short (20 minutes)

before 3pm

may affect some people more than others

OT Interventions

educating clients and caregivers on sleep expectations and misconceptions

modifying one’s sleep environment (sleep hygiene)

encouraging health management behaviors

screen for sleep concerns

interventions that address physical activity and daytime routines

white noise, sleep tracker, eye masks

Non-Pharmacologic Treatment

CBT-i (for insomnia)

mindfulness based stress reduction

physical activity

exposure to daylight (bright light therapy)

acupuncture

diet

sleep hygiene

Pharmacologic Treatment

should only be used for short term management insomnia!!

benzodiazepines

non-benzodiazepines hypnotics

melatonin receptor agonists

anti-depressants

antihistamines

melatonin

valerian root

Sleep Safety

keep phone by the bed

light within reach (or automatic)

reduce hazards in the bedroom

Sleep Positioning

back is the best BUT it can make snoring worse and found correlation with sleep paralysis

studies have found that people might be more likely to have nightmares when sleeping on their left side

Sleep Hygiene

refers to health habits, behaviors and environmental factors that contribute to sleeping well on a daily basis

Preparing for Bed

everyday: stick to a sleep schedule

4-6 hours: avoid caffeine intake

90 minutes: avoid vigorous exercise

30 minutes: discontinue electronic use

15 minutes: begin sleep ritual

Creating a Healthy Sleep Environment

turn off/down the lights

reduce sound

reduce temperature

select supportive bed and pillow

wash bedding regularly

create clean, clutter free space

Importance of Sleep

helps mental health

helps Brian health

reduces disease risk

Sleep Difficulties

social and behavioral phenomena → routines changed or disrupted

stimulants

misuse of prescription and over the counter medication

age related cell death in the suprachiasmatic nuclei (SCN) of the hypothalamus

changes to other body systems

sleep ability

sleep need

sleep opportunity

Sleep Need

minimum hours of quality sleep a person needs for effective daytime functioning

Sleep Opportunity

the availability of a sleep environment (time and place) that can support quality sleep

Sleep Ability

number of hours of quality sleep each night a person is presently getting