Psychological Health and Wellbeing Noted.docx

Psychological Health and Wellbeing Notes

What is mental health?

Mental health is more than the absence of mental disorders and is intrinsic to overall health and wellbeing.

The World Health Organisation (WHO) states ‘Mental health is a state of wellbeing in which an individual realises his or her or their own abilities, can cope with the normal stresses of life, can work productively and is able to contribute to his or her or their community.’

Risk Factors

Risk factors are anything that may increase the likelihood of developing a mental illness. Below are the most commonly identified.

Child

• Genetic influences
• Low IQ and learning difficulties
• Specific development delay
• Communication difficulties
• Physical Illness
• Low-self esteem

Family

• Family disharmony or break up
• Inconsistent discipline styles
• Parent/s with mental illnesses and/or substance abuse
• Physical, sexual and/or emotional abuse/neglect
• Parental criminality or alcoholism
• Death and loss

School

• Bullying
• Discrimination
• Breakdown or lack of positive friendships
• Peer pressure
• Poor pupil to teacher relationships

Community

• Socio-economic disadvantage
• Homelessness
• Disaster, war, accidents or other overwhelming events
• Discrimination
• Other significant life events
• Lack of access to support services

Protective Factors

Protective factors are anything that may decrease the likelihood of developing a mental illness. Below are the most commonly identified.

Child

• Secure attachment experience
• Good communication skills
• Having a belief in control
• Positive attitude
• Experiences of success and achievement
• Capability to reflect

Family

• Family harmony and stability
• Supportive parenting
• Strong family values
• Affection
• Clear, constant discipline
• Support for education

School

• Positive school climate that enhances belonging and connectedness
• Clear policies on behaviour and bullying
• ‘Open door’ policies for children who raise problems
• A whole school approach to promoting good mental health

Community

• Wider support network
• Good housing
• High standard of living
• Opportunities for valued social roles
• Range of sport/leisure activities

Biopsychosocial Model

Biological: presumes that abnormality are best understood as illnesses or diseases and as such, all treatments are based on medical therapies i.e. drugs and ECT.

Psychological: whilst much of the factors are universal across all humans, it questions how, why and when dysfunction occurs, and proposes that individual differences cause the development of mental illness.

Social: examines the abnormalities of the outcome of an individual’s living environment that creates problems, examples being racism, poverty, dysfunctional institutions and poor family communication.

DSM-5

• The Diagnostic and Statistical Manual (DSM-5) describes mental disorders as ‘syndromes characterised by clinically significant disturbances in an individual’s cognition, emotional regulation, or behaviour that reflects a dysfunction in psychological, biological or developmental processes underlying mental functioning.’
• Usually associated with significant distress or disability in social, occupational or other important activities.
• Expectable or culturally approved response to a common stressor such as death of a loved one is not a mental disorder.
• Major problem with DSM-V mental disorder definitions are that they are culturally constructed, meaning they do not take into account cultural differences in behaviours and practices.
• In many cultures, the examples pictured would be seen as ‘abnormal’, however there are many other cultures globally that make modifications to their body for traditional or religious purposes.
• The photos, once put into context, no longer fit the criteria of ‘abnormality’ or being ‘mentally ill.’
• Clinicians need to understand the cultural background of their patients including attitudes and belief systems.

How History Plays a Role

• Important to acknowledge that culture plays a significant role in mental health e.g. whether people seek help, how they describe their symptoms, if mental illness is culturally accepted and how much stigma they attach to the illness.
• Significant advancements in science, research and cultural development has resulted in increased acceptance and treatment of mental illness.
• In ancient times it was believed that psychological distress was caused by demons, this exorcisms were common. Another treatment was trephination, which was a procedure involving drilling holes into the skull.
• Middle of 19th century saw push for more humane asylums for mentally ill as psychology advanced.
• Treatment for mental illness traced back as early as 1550 BC in Ancient Greece and Egypt. Mainly lists of combinations of plants and animals.
• Evidence suggests not enough distinction between physical and mental illness known.
• Middle of 19th century saw push for more humane asylums for mentally ill as psychology advanced.
• By the mid-1940s, electric shock therapy, insulin shock therapy and lobotomies common to treat mental illness.
• Treatment of mental illness today far more ethical and based on scientific research.

Impact of Culture on Behaviour

• Early psychological researchers were unaware of the impact of culture on the interpretation of behaviours and assumed that all behaviours were universal.
• Research conducted by Cochrane (1977) reported that within western society Black Afro-Caribbean immigrants were approximately five times more likely to be diagnosed with schizophrenia than native people.
• Cochrane proposed that one reason that could account for this difference is that doctors are using Western cultural norms when evaluating and interpreting people’s behaviour.
• Cultural bias and interpretation could lead to a mistaken diagnosis – as any behaviour which deviates from Western norms could be mistaken as being abnormal.
• The DSM-IV states that the relationship between clinician and patient could be affected by cultural differences, yet despite the revision to the DSM-V to enhance cultural context of diagnosis, Lopez and Guarnaccia 2000, argue that the manual remains ethnocentric and rests upon a narrow understanding of culture.
• Therefore, concerns exist around the accuracy of making a diagnosis for people where there are cultural differences and/or a lack of knowledge about a person’s culture between the clinician and the patient.

Ethnocentric Bias

Ethnocentric bias is a cultural or ethnic bias that makes us view the world from the perspective of our own group. It is a form of distortion that leads us to judge other cultures based on the values and standards of our own culture.

Influences of Social Media

• Social Media (SM) has an undeniable influence on daily life with both positive and negative effects on users, especially with regard to its impact on mental health.
• As early as 1998, Kraut and others conducted research and reported that online activities cause users to engage in fewer in person interactions leading to problems with psychological well-being.
• Research shows that participation in social media can help promote healthy behaviours, including weight loss and exercise as there are supportive applications to track progress, like-minded social groups to share progress, receive praise and recognition for achieving your goals.
• The study of negative effects of social media use has received greater attention especially with psychological distress leading to obvious outcomes such as the sharing of risky behaviours, cyber bullying and self-comparison with others.

Social Media Addiction

• When you post a picture to Instagram or Facebook your brain releases a dopamine hit that makes you happy. Once you see all the notifications for likes and positive comments popping up on your screen, you’ll subconsciously register it as a reward.
• Addictions can be chemical or behavioural. Traditionally, the term addiction has been used for people whose drug or alcohol use has become a serious problem. But today, many mental health specialists agree that behaviours can be addictive, too.
• Used by mental health professionals to diagnose mental health disorders the DSM-5 was last published in 2013. Addiction to gaming was listed as a “condition for further study” – indicating that this was on the list of addiction requiring more research before being included as a diagnosable addiction.
• There is neurological research showing similarities in changes in the brain between video gaming and addictive substances, however gambling disorder is the only behavioural addiction identified in DSM-5 at the moment.

FOMO
The idea that you might miss out on something if you’re not online can affect your mental health with research showing a correlation of increased anxiety and depression in youth.

Self-image issues
Social media sites provide tools that allow people to earn others’ approval for their appearance and the possibility to com-pare themselves to others.

Online v Reality
social media itself is not the problem. It is the way people use it in place of actual communication and in-person socialising. “Friends” on social media may not actually be friends and may even be strangers.

Increased Usage
The more time spent on social media can lead to cyberbullying, social anxiety, depression, and exposure to content that is not age appropriate.

Behavioural Addictions

There is no single agreed definition for behavioral addictions. But they are generally defined similarly to drug and alcohol addiction.

1. You can’t stop doing it
2. You can’t stop thinking about it.
3. You have trouble managing your emotions.
4. It interferes with your daily life or your relationships.
5. You have less awareness of the negative consequences.

Depression

What is depression?

An extended experience of negative emotions, thoughts, behaviours and functioning for at least two weeks.

• One of the most common mental health disorders.
• Necessary to examine depression from the biopsychosocial model.

Biological

• Whilst no one is sure how depression develops, change in the brain chemistry is likely.
• Reduced levels of serotonin (associated with feeling content).
• Common amongst families, thought to be hereditary.
• Overuse of substances such as alcohol and drugs is associated with higher vulnerability to depression

Biological Symptoms of Depression

• Headaches
• Digestion issues
• Chronic pain
• Insomnia
• Increase or decrease in appetite
• Imbalance of serotonin
• Inactive left front lobe of brain
• Genetic inheritance
• Increased daytime fatigue

Psychological

• Women more likely to be diagnosed with depression than men – vulnerable at beginning of adolescents, childbirth and menopause.
• Men appear to be more vulnerable at retirement, during long periods of unemployment and following separation from a partner.
• Research shows people who develop depression have personality types which include less flexibility, strongly emotional and worriers.

Psychological Symptoms of Depression

• Feelings of increase sadness
• Low self esteem
• Learned helplessness
• Thoughts of suicide and/or self-harm in serious cases
• Loss of once pleasurable activities
• Poor judgement
• Lowered comprehension
• Impulsivity
• Pessimistic

Social

• People without supportive social networks are more vulnerable to depression.
• In some cultures, depression is considered ‘shameful’, and stigma of mental illness is very apparent.
• Several social factors can exacerbate or cause depression, such as natural disasters, COVID19, family death and conflict etc.

Social Symptoms of Depression

• Diminished involvement with others
• Strained relationships with family and friends
• Loss of social skills
• Inappropriate/maladaptive social behaviour
• Victim and/or perpetrator of abuse

Biological Treatments for Depression

Anti-depressant medication

• Several different types of anti-depressants.
• Most common ones in Australia are Selective Serotonin Reuptake Inhibitors (SSRIs) – these help to enhance the function of nerve cells in the brain that regulate emotions.

Electric Shock Therapy (Also known as electroconvulsive therapy- ECT)

• Involves passing a carefully controlled electric current through the brain which affects the brains activity with the aim of reducing severe depressive symptoms.
• Modern day ECT is very safe however has risk factor of reducing memory, so is only used when absolutely necessary,

Medications

Advantages

• Can allow people to function day to day far more effectively.
• Used in conjunction with psychological therapy > typically more successful in reducing mental illness.
• Readily available in Australia.

Disadvantages

• May have negative side effects.
• Can become addictive (benzodiazepines in particular).
• May take several trials of different medications to find the right one, as well as the right dosage.
• Can take a long time to work i.e. more than two weeks.

Electric Shock Therapy (ECT)

Advantages

• Modern day ECT very safe – delivered by trained health professionals.
• Can be very effective in treating severe mental illness.

Disadvantages

• Is an intrusive procedure.
• Can cause memory problems due to changes in brain.
• May not work for everyone.

Psychological Treatments for Depression

Cognitive Behavioural Therapy (CBT)

• Structured psychological treatment which recognises the way we think (cognition), and act (behaviour) affects the way we feel.
• Involves a professional therapist to identify thought and behaviour patterns that make someone more likely to be clinically depressed.
• One of the most effective treatments of depression and is useful for all age groups.

Interpersonal Therapy (IPT)

• Focuses on problems with personal relationships and the impact they can have on developing depression.
• IPT helps to recognise patterns in relationships that make people more vulnerable to depression, and by identifying patterns can help client improve on these relationships, hence, reduce symptoms of depression.

Cognitive Behavioral Therapy (CBT)

Advantages

• Evidence for longer, more extended success
• Can use strategies again if symptoms resurface
• Applicable to all age groups and demographics, men and women.

Disadvantages

• Sometimes difficult to change thought process for severe depression and/or anxiety.
• Can be very confronting being diagnosed.
• Can be very expensive.

Social Treatments for Depression

Support groups and services

• Belonging to a recognised support group for depression seen to have positive results.
• Hearing and talking to other who know what client is going through promotes feelings of belonging and not being alone.
• Can do this both in person and online.

Anxiety

What is anxiety?

Many different types of anxiety disorders, however all of them have the experience of strong and/or frequent anxiety or fear.

Different anxiety disorders include:

• Phobias
• Panic disorder
• Obsessive-compulsive disorder (OCD)
• Post traumatic stress disorder (PTSD)
• Generalised anxiety disorder (GAD)
• Social phobia

Biological

• Flight or fight response much more active.
• Some research suggests that there are genetic markers for vulnerability to anxiety disorders.
• Evidence to also support it is genetic.

Biological Symptoms of Anxiety

• Headaches
• Trembling
• Nausea
• Muscle tension
• Dizziness
• Insomnia
• Genetic factors
• Heart palpitations
• Chest pain
• Sweating
• Tingling sensations

Psychological

• Anxious people often have interpretation bias where they perceive information form others as negative towards themselves.
• Often memory is impaired due to inattention to task and worry about other aspects.
• Takes into account an individual’s past experiences, personality style, attitudes and beliefs and stress management skills.
• Women more likely to be diagnosed with anxiety disorders than men.

Psychological Symptoms of Anxiety

• Magnify threats and failures
• Fear, worrisome thoughts
• Irrational fears
• Fear of panic and public scrutiny
• Hypersensitive to criticism
• Worried about potential mistakes
• Avoidance
• Persistent unwanted thoughts
• Feelings of anxiety, confusion, resentfulness
• High neuroticism

Social

• Anxiety disorders can develop from a traumatic event based a person's social, socio economic, political, religious or cultural affiliation.
• Examples include:
• War
• Abuse
• Poverty
• COVID19

Social symptoms and factors of Anxiety

• Fast paced lives
• Environmental stressors
• Decreased job security
• Lack of family support
• Avoidance of groups, work colleagues etc.
• Avoidance of social contact, crowds
• Social phobias
• Difference between cultures

Biological Treatments for Anxiety

Anti-anxiety medication

• Most common type are benzodiazepines- type of tranquillizers and/or sleeping pills (depends on type)
• Promote relaxation and reduces muscle tension.
• Should only be used for short amount of time as they become addictive.
• Should also be used in conjunction with other treatments, not as only treatment for anxiety.

Anti-depressant medication

• Some types of anti-depressants effective for anxiety, even if client is not experiencing depression symptoms.
• Correct the imbalance of chemical messages between nerve cells and the brain.

Psychological Treatments for Anxiety

Cognitive behavioural therapy (CBT)

• Structured psychological treatment which recognises the way we think (cognition), and act (behaviour) affects the way we feel.
• Involved a professional therapist to identify thought and behaviour patterns that make someone more likely to be anxious.
• By making client more aware of the thoughts and behaviours, client can start to make changes to thoughts, which will in turn improve coping skills.
• One of the most effective treatments of depression and is useful for all age groups.

Social Treatments for Anxiety

Support groups and services

• Belonging to a recognised support group for anxiety seen to have positive results.
• Hearing and talking to other who know what client is going through promotes feelings of belonging and not being alone.
• Can do this both in person and online.

Mental Health Stigma

• There is still great stigma in society towards mental illness in general, largely because people misunderstand what it is.
• There is no evidence to suggest there is a link between mental illness and violence, and this notion should not be used to reinforce stigma and discrimination against people.

Men

• Significant amount of stigma regarding gender expectations in society, especially in men's health.
• Statistics from 2017-2012 show that on average, approximately six men will take their own lives in Australia every day.
• Leading cause of death in Australian men aged between 15-44. More than double the national road toll.
• More recent advertising campaigns targeting men and boys. ‘Movember’ one of the most internationally recognised.

Behaviour Modification

• Behaviour modification is a psychological intervention used by psychologists to modify a specific problem behaviour that is impacting a person’s ability to function normally.
• Teachers and parents also use behaviour modification techniques, although they might not realise that the strategies they use to change a child’s behaviour have a formal title, they just use the principles of be-haviour modification to encourage their child to eat properly, or go to bed on time, or spend less time on video games.
• Behavioural psychologists believe that behaviours are learned. As a result of this belief, if behaviours can be learned it is logical that behaviour can be “unlearned’ and new behaviours can be learned to replace existing behaviours.

Sleep

Sleep is important for mental health

• Getting enough sleep is very important to ensure positive mental health.
• Sleep deprivation has a negative effect on psychological state, and people with existing mental health disorder are more likely to have insomnia or other sleep disorders.
• About 40-50% of people with insomnia (inability to get to sleep and/or stay asleep) also have a mental health disorder.
• If you are not getting the recommended 8-10 hours’ sleep per night as year 12 students and think you can survive on 7 hours or less as a teenager, it's time to consider the research that suggests that sleeping is essential.

Circadian Rhythms

Sleep/wake circadian rhythm.

• Humans level of alertness at lowest in early hours of the morning and peak in the late afternoon.
• However does depend on factors such as sleep debt, sunlight, shift work and interest level in tasks called zeitgebers.
• Circadian rhythms are controlled by areas in the brain.
• The most obvious zeitgeber is daylight. When daylight hits your eyes, cells in the retinas signal your brain.
• Other zeitgebers are sleep, social contact and even regular meal times.
• The sleep/wake cycle is controlled by the suprachiasmatic nucleus (SCN), which is a small cluster of nerve cells located in the hypothalamus in the brain.
• SCN is a ‘biological clock’ that keeps track of time of day. Light is the main external cue that syncs this clock.
• There are receptors in the back of the retinas of our eyes that detect the level of light.
• Converted into an electrical impulse that travels from the retina to the SCN, which responds to changes in light.
• SCN sends messages to brain and body that help them adapt to whether it is day or night.
• SCN controls the sleep/wake cycle by sending messages to the pineal gland in the brain which adjust melatonin levels.
• Melatonin: hormone that tells the body whether it should be awake or asleep.
• Melatonin levels are at their highest at night and at their lowest during the day.
• Light inhibits the secretion of melatonin.

Sleep Stages

• Sleep is made up of 5 stages, each with different characteristics.
• The first four stages are generalised as non-REM sleep, and the fifth stage is REM sleep.
• Humans have around 4-6 sleep cycles each night, and each cycle last around 90-110 minutes.
• The first sleep cycle, humans only get approximately 10 minutes of REM sleep. This then increases to 30-60 minutes by the last cycle.

Measuring Sleep

• Sleep is objectively measured using various methods:
• Electroencephalograph (EEG) which measures brain wave patterns during sleep.
• Electrooculogram (EOG) which measures eye movement during sleep.
• Electromyogram (EMG) which measures the activity of muscles during sleep.

Electroencephalograph (EEG)

• Electroencephalograph (EEG) which measures brain wave patterns during sleep.
• Can tell what stage of sleep, how much a person gets etc.

Electrooculogram (EOG)

• Electrooculogram (EOG) which measures eye movement during sleep.
• Can tell is someone is in NREM or REM by their eye movements.

Electromyogram (EMG)

• Electromyogram (EMG) which measures the activity of muscles during sleep.
• Can tell which stage of sleep a person is in by measuring their muscle movement.

Stages of Sleep

Stage 1 (Awake)

• Described as ‘relaxed wakefulness
• Alpha and Theta brain waves present on EEG
• Reduced brain activity
• Rolling eye movements
• Slowed breathing and heart rate
• Reduced muscle activity
• Hypnic jerks
• Last approximately 10 minutes

Stage 2 (Light)

• Sleep spindles and K-complexes on EEG (slower brain wave activity)
• Medium amplitude in muscle movement
• No eye movement
• Temperature, heart rate, breathing and blood pressure continue to drop
• Last about 20 minutes

Stage 3 (SWS)

• Slow waves appear called Delta waves
• Delta waves make up 20 – 50% of brainwave activity
• Medium to low amplitude in muscle tension
• No eye movement
• Heart rate, breathing, blood pressure and temperature continue to drop
• Lasts about 15 minutes

Stage 4 (SWS)

• Deepest stage of sleep
• Delta waves account for more than 50% of brain wave activity
• Little to no muscle movement
• No eye movement
• Breathing at its slowest and deepest
• Hard to wake someone from this stage. If awoken person is confused and disorientated
• Amount of SWS > how restored a person feels
• Stage 3 and 4 combined lasts about 30 mins

Stage 5 (Dreams)

• Sleep ‘lightens’ and moves back through stages 4-3-2 to a unique stage (REM)
• ‘Rapid eye movement’ > eyes moving around
• People report ‘dreaming’
• EEG in REM similar to an awake person
• Beta and some alpha waves present
• Pulse, breathing, blood pressure quicken
• Eyes move around very quickly
• Stages 1,2,3,4,3,2,REM,1 = one sleep cycle
• Most of us go through the above process 4-6 times a night.
• Humans get most of their restorative sleep (SWS) in the first sleep cycle, and most of their dreaming sleep in the last sleep cycle as REM increases.

Theories of Sleep

Repair and Restoration Theory

• Sleep repairs and restores basic body functions and strengthen your immune system. Substantial cell repair and protein synthesis occurs during sleep.
• Research from several universities and technology institutions through experiments with mice show that signals in the brain that modulate the sleep/wake state also act as a ‘switch’ that turns the immune system off and on.
• Therefore during periods of sleep, the immune system strengthens, which is why when you are sick, your body needs and wants to sleep when it would not be typical.

Clean-up Theory

• Similar to repair and restoration theory, research from 2013 shows that the brain uses periods of sleep to flush waste and toxins from the body.
• The brain has two functional states: awake and alert, or asleep and ‘cleaning up.’
• This clean up works like a waste disposal system, clearing out waste products that brain cells generate.
• The 2013 research also suggests that issues with clearing out brain waste might be a factor in the development of certain brain disorders such as Dementia, Parkinson's and Alzheimer's.

Evolutionary Theory

• This theory hypothesises that one reason for sleep is to conserve energy with periods of inactivity.
• All animals (including humans) have adapted over time to sleep during periods of time when being awake is dangerous.
• Humans are most productive during the day, and able to rest at night. In prehistoric times, it was harder to get food, so by sleeping for some of the day (i.e. naps) humans could conserve energy.
• Predatory animals such as lions and bears can sleep 12-15 hours a day to lack of threats, whereas other animals with many predators can only sleep in short bursts.

Information Consolidation Theory

• REM sleep plays a vital role in memory retention and consolidation, removal of unwanted information and storge of important data from memory.
• Sleep ensures the consolidation and sorting of important information into short- and long-term memory. This takes place during slow wave sleep (SWS – deep sleep).
• Several researchers have concluded that a lack of sleep has a serious impact on the ability to recall and remember information.

Sleep Debt and Deprivation

Sleep Debt

• Accumulation of the difference between the amount of sleep that a person needs to function at an optimal level and the amount they actually have.
• E.g. if a person needs 8 hours each night but only gets 7, they have a sleep debt of 1 hour.
• Our desire to sleep during the day increases the more sleep debt we have.
• However sleep debt does not continue to build up over a lifetime.

Sleep Deprivation

• When a person does not get the required amount of sleep to function at the optimal level.
• Common symptoms include increased daytime sleepiness, irritability, hand tremors, slower reaction time, poorer memory and microsleeps.
• In today’s society, the average individual is getting just over 6 hours sleep.
• Consistent reduction of recommended sleep can increase the risk of cancer, infection, obesity, cardiovascular disease and diabetes in adults.

Types

Partial

• Occurs when people don’t get enough sleep most days of the week.

Continuous

• When people don’t sleep at all for a period of time. Often used in training exercises for the army.
• Research on continuous sleep deprivation shows that on the second night of deprivation, people fall asleep but deny it. On the third day they become tense apathetic, irritable, have mood swings and microsleeps and may experience hallucinations. By the fourth day people are showing paranoia.

Factors Influencing Sleep Deprivation – SOCIAL

• Co-sleeping and parenting choices - bed sharing, room sharing, sleeping with a baby or pet.
• Media use – social media, web surfing, TV, gaming. Excessive usage leads to insomnia and depression.
• Extracurricular activities – sport, social lives, clubs, part time work.
• Homework time – adolescence that spend more than 5 hours on homework per week are more likely not to meet minimum sleep guidelines. Coupled with the exposure to light from devices.
• School schedule – Consideration to the different age groups sleep needs is not taken into consideration with school/work starting times. Majority of students at school at 8:30am and adults at work by 9:00am.
• Shift work – work that falls outside the hours of 6:00am and 7:00pm. Includes industries such as nursing, medicine, factory work, vintage, hospitality etc. 1 in 5 shift workers develop shift work disorder, where they are far more likely to develop insomnia and other negative health issues.
• Jet lag - The suprachiasmatic nucleus recognises the time of day to be different from what external cues tell us. Due to travelling through several time zones. On average, it takes one day of adjustment for every hour of time zone change i.e. 5-hour time difference = 5 days for circadian rhythm to adjust.

Factors Influencing Sleep Deprivation – PERSONAL

• Personal choices – driven by voluntary choices i.e. choose to stay up later to watch TV.
• Sleep disorders – insomnia, sleep apnoea and narcolepsy. All reduce sleep quality and quantity.
• Medical or health problems – pain, anxiety disorders, substance misuse, depression, obesity and schizophrenia.
• Delayed Sleep Phase Syndrome – when a person’s sleep is delayed by two hours or more of what is considered acceptable. Causes difficulty in being able to wake up at desired time. Approximately 7-16% of young people report difficulty with DSPS.
• Stress – heightened state of physiological arousal. The National Sleep Foundation has found that 43% of people aged between 13-64 have reported lying awake at night due to stress at least once in the past month.

Sleep Hygiene

A series of habits that can improve your ability to fall and stay asleep

• Keep a consistent sleep schedule. Get up at the same time each day, give or take half an hour.
• Set a bedtime early enough for you to get at least 8-10 hours’ sleep.
• Don’t go to bed unless you are sleepy.
• If you don’t fall asleep after 20 minutes, get out of bed. Do an activity without a lot of light (don’t go on your phone!)
• Establish a bedtime routine i.e. devices away at 9:30pm, brush teeth, water, read book, lights off at 10:00pm.
• Use your bed only for sleep and sex.
• Avoid sleeping other places that are not your bed i.e. an armchair.
• Make your room quiet and relaxing. Keep the room at a comfortable, cool temperature.

Very important to maintain overall health and wellbeing

• Limit exposure to bright light in the evenings.
• Turn off electronic devices at least 30 minutes before bedtime.
• Don’t eat a large meal before bedtime. If you are hungry, eat a light healthy snack.
• Exercise regularly and maintain a healthy diet.
• Avoid consuming caffeine in the afternoon or evening.
• Avoid consuming alcohol before bedtime.
• Reduce your fluid intake before bedtime.