falling asleep and staying asleep: how to make small

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USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy Falling Asleep and Staying Asleep: How to Make Small Changes that Improve Your Sleep Laura Cox, OTD, OTR/L Assistant Professor of Clinical Occupational Therapy USC Occupational Therapy Faculty Practice

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Page 1: Falling Asleep and Staying Asleep: How to Make Small

USC Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy

Falling Asleep and Staying Asleep: How to Make Small Changes that

Improve Your Sleep

Laura Cox, OTD, OTR/L

Assistant Professor of Clinical Occupational Therapy

USC Occupational Therapy Faculty Practice

Page 2: Falling Asleep and Staying Asleep: How to Make Small

helping people do whatthey want and need to do

looking at the relationships betweenhealth, well-being, and daily activities

Occupational Therapy

Created by Samantha Valasek, OTD, OTR/L

Page 3: Falling Asleep and Staying Asleep: How to Make Small

USC Occupational Therapy Faculty Practice

• Chronic Condition Management, for example obesity, diabetes, pain, headaches, neurological conditions, ASD, ADHD, & more

• Mental Health & Stress

• Adult & Adolescent Wellness

• Healthy Aging / Aging in Place

Created by Samantha Valasek, OTD, OTR/L

Page 4: Falling Asleep and Staying Asleep: How to Make Small

Our Clinic During the Pandemic

Page 5: Falling Asleep and Staying Asleep: How to Make Small

Sleep

Page 6: Falling Asleep and Staying Asleep: How to Make Small

Today’s Agenda

• Importance of sleep

• How sleep works

• Age-related sleep changes

• Sleep hygiene

Page 7: Falling Asleep and Staying Asleep: How to Make Small

WHY IS SLEEP IMPORTANT?

Page 8: Falling Asleep and Staying Asleep: How to Make Small

Impact of Sleep Loss

• Decreased motor performance

• Mood effects

• Impaired cognition

• Increased appetite and food intake

• Impaired immune response

• Increased risk for…

– Hypertension

– Stroke

– Obesity

– Diabetes

(Czeisler, 2015; Roberts & Duong, 2014; Maglione et al., 2014; Kuo, 2001)

Page 9: Falling Asleep and Staying Asleep: How to Make Small

Benefits of Sleep

• Improved immune functioning

• Increased metabolism

• Enhanced memory and learning

• Reduced stress

• Reduced risk for motor vehicle accidents

• Increased creativity

(Czeisler, 2015; Roberts & Duong, 2014; Maglione et al., 2014; Kuo, 2001)

Page 10: Falling Asleep and Staying Asleep: How to Make Small

HOW DOES SLEEP WORK?

Page 11: Falling Asleep and Staying Asleep: How to Make Small

Sleep is a Reflex

IF YOU FORCE SLEEP, IT WILL NOT HAPPENModified from Samantha Valasek, OTD, OTR/L

Page 12: Falling Asleep and Staying Asleep: How to Make Small

Sleep Stages and Cycles

(Manber & Carney, 2015)

Created by Samantha Valasek, OTD, OTR/L

Page 13: Falling Asleep and Staying Asleep: How to Make Small

Sleep Drive

(Adapted from Carney & Manber, 2009)

How much our bodies want to sleep

Created by Samantha Valasek, OTD, OTR/L

Page 14: Falling Asleep and Staying Asleep: How to Make Small

Circadian Rhythm

(Manber & Carney, 2015)

Alerting signals that cycle every 24 hours

Created by Samantha Valasek, OTD, OTR/L

Page 15: Falling Asleep and Staying Asleep: How to Make Small

Sleep Drive and Circadian Rhythm Interaction

HIGH sleep drive + LOW alerting signals = SLEEPRegulators: sunlight exposure, core body temperature, sleep-wake schedule

consistency, daily activity levels(Eakman & Rolle, June, 2018)

Modified from Samantha Valasek, OTD, OTR/L

Page 16: Falling Asleep and Staying Asleep: How to Make Small

Sleep Over the Lifespan

Age Range Recommended Range (hrs)

May Be Appropriate (hrs)

Not Recommended (hrs)

Newborn (0-3 mos) 14-17 hours 11-13, 18-19 <11, >19

Infant (4-11 mos) 12-15 10-11, 16-18 <10, >18

Toddler (1-2 yrs) 11-14 9-10, 15-16 <9, >16

Preschool (3-5 yrs) 10-13 8-9, 14 <8, >14

School Age (6-13 yrs) 9-11 7-8, 12 <7, >12

Teenager (14-17 yrs) 8-10 7, 11 <7, >11

Young Adult (18-25 yrs) 7-9 6, 10-11 <6, >11

Adult (26-64 yrs) 7-9 hours 6-10 hours Less than 6More than 10

Older Adult (65+ yrs) 7-8 hours 5-9 hours Less than 5More than 9

(National Sleep Foundation, 2018)

Created by Samantha Valasek, OTD, OTR/L

Page 17: Falling Asleep and Staying Asleep: How to Make Small

How are you sleeping?

Page 18: Falling Asleep and Staying Asleep: How to Make Small

Age-related Changes in Sleep

• Getting tired earlier in the evening

• Waking up earlier in the morning

• Increased waking up in the middle of the night

• Difficulty falling back asleep upon waking

• Insomnia (difficulty falling and/or staying asleep)

(FamilyDoctor.org, 2019; Newsom, 2020)

Page 19: Falling Asleep and Staying Asleep: How to Make Small

Why Do These Changes Occur?

• Reduced melatonin production

• Health conditions– Diabetes, prostate issues, depression, anxiety,

pain

• Medication side effects

• Lifestyle changes– Reduced light exposure

– Increased napping

– Not keeping a consistent sleep schedule

(FamilyDoctor.org, 2019; Newsom, 2020)

Page 20: Falling Asleep and Staying Asleep: How to Make Small

Sleep Hygiene

Page 21: Falling Asleep and Staying Asleep: How to Make Small

What is sleep hygiene?

A variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness

National Sleep Foundation

Created by Samantha Valasek, OTD, OTR/L

Page 22: Falling Asleep and Staying Asleep: How to Make Small

What impacts our sleep?

• Sleep schedule• Sleep environment• Exposure to stimulants• Time in bed• Evening routine• Daytime activity

National Sleep Foundation

Created by Samantha Valasek, OTD, OTR/L

Page 23: Falling Asleep and Staying Asleep: How to Make Small

How can you improve your sleep?

Sleep schedule• Keep a consistent sleep schedule

• *Even on weekends(Åkerstedt, et al., 2018)

• Avoid napping if possible• 20 minutes recommended• Between 1pm and 3pm is best

(Chinoy, et al., 2016)

• Follow a sleep schedule congruent with chronotype

Modified from Samantha Valasek, OTD, OTR/L

Page 24: Falling Asleep and Staying Asleep: How to Make Small

How can you improve your sleep?

Sleep environment• Dim or Dark Lighting

• Curtains or window tints

• Eye mask• Limit Sound

• Silence • White noise• Meditation, lullaby

or bedtime story

• Cool Temperature• Open windows• Fans or air

conditioning• Breathable sheets

and sleep wear• Put clock under bed or

turn it around

Modified from Samantha Valasek, OTD, OTR/L

Page 25: Falling Asleep and Staying Asleep: How to Make Small

Sleep Positioning

Modified from Samantha Valasek, OTD, OTR/L

Page 26: Falling Asleep and Staying Asleep: How to Make Small

How can you improve your sleep?

Exposure to stimulants• Limit caffeine and nicotine

• Stop 4-6 hours before bed• Decrease stress and anxious thinking

• Meditation or deep breathing• Journal• Make plans/lists

• Limit screen use• Stop 1 hour before bed

Modified from Samantha Valasek, OTD, OTR/L

Page 27: Falling Asleep and Staying Asleep: How to Make Small

How can you improve your sleep?

Food and Drink• Do not go to bed hungry

• But avoid greasy/heavy foods before bed• Avoid excessive liquids in the evening

• Monitor 4-6 hours before bed• Avoid alcohol, especially in the evenings

• Causes shallow sleep and earlier waking

Page 28: Falling Asleep and Staying Asleep: How to Make Small

How can you improve your sleep?

Time in bed• If you can’t fall asleep or can’t fall back asleep…

• Get up after 20 minutes• Leave the bedroom• Engage in a quiet activity until sleepy• Focus on relaxation, not sleep

• Reserve the bed for ONLY sleep and sexual activity

Modified from Samantha Valasek, OTD, OTR/L

Page 29: Falling Asleep and Staying Asleep: How to Make Small

How can you improve your sleep?

Evening routine• Create a wind-down routine

• Decrease stimulation over several hours• Keep a consistent sequence• Build in cues

6pm 8pm 10pm

Created by Samantha Valasek, OTD, OTR/L

Page 30: Falling Asleep and Staying Asleep: How to Make Small

Winding Down Your Mind

• Scheduled worry

• Constructive worry

• Pre-sleep writing

• To-do list for tomorrow(Carney & Manber, 2009; Manber & Carney, 2015)

Created by Samantha Valasek, OTD, OTR/L

Page 31: Falling Asleep and Staying Asleep: How to Make Small

Sleep PreparationConsistent and Ritualistic

• Prepare your environment

• Engage in self-care activities

• Promote relaxation

What do you do to prepare for sleep?

6pm 8pm 10pm

Sleep preparation activities

Page 32: Falling Asleep and Staying Asleep: How to Make Small

How can you improve your sleep?

Daytime activity• Exercise• Get sun exposure• Avoid overstimulation• Avoid understimulation

Created by Samantha Valasek, OTD, OTR/L

Page 33: Falling Asleep and Staying Asleep: How to Make Small

So what impacts our sleep again?

Basically everything.

Just pick one small changeto get started.

Created by Samantha Valasek, OTD, OTR/L

Page 34: Falling Asleep and Staying Asleep: How to Make Small

• Sleep schedule• Sleep environment• Exposure to stimulants• Time in bed• Evening routine• Daytime activity

Page 35: Falling Asleep and Staying Asleep: How to Make Small

Want more help?

USC Occupational Therapy Faculty Practice

Lifestyle Redesign® Telehealth Services

• To schedule an evaluation, please call 323-442-3340 or email [email protected]

– A referral from your doctor is likely needed

• Want to determine if Lifestyle Redesign® is right for you?

– Call or email to request a free 15-minute consultation with a clinician

Page 36: Falling Asleep and Staying Asleep: How to Make Small

Sweet Dreams!

Laura Cox, OTD, OTR/[email protected]

Page 37: Falling Asleep and Staying Asleep: How to Make Small

ReferencesAmerican Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC.

Åkerstedt, T., Ghilotti, F., Grotta, A., Zhao, H., Adami, H., Trolle-Lagerros, Y., & Bellocco, R. (2018). Sleep duration and mortality - Does weekend sleep matter? Journal of Sleep Research, e12712 DOI: 10.1111/jsr.12712

Araghi, M. H., Chen, Y. F., Jagielski, A., Choudhury, S., Banerjee, D., Hussain, S., ... & Taheri, S. (2013). Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis. Sleep, 36(10), 1553-1562.

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Cleveland Clinic (2018). Parasomnias and disruptive sleep disorders. Retrieved from: https://my.clevelandclinic.org/health/diseases/12133-parasomnias--disruptive-sleep-disorders

Czeisler, C. A. (2015). Duration, timing and quality of sleep are each vital for health, performance and safety. Sleep Health: Journal of the National Sleep Foundation, 1(1), 5-8.

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ReferencesFrank, E., Soreca, I., Swartz, H. A., Fagiolini, A. M., Mallinger, A. G., Thase, M. E., Grochocinski, V.J., Houck, P.R. & Kupfer, D. J. (2008). The role of interpersonal and social rhythm therapy in improving occupational functioning in patients with bipolar I disorder. American Journal of Psychiatry, 165(12), 1559-1565.

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ReferencesKirsch, D. B. (2014). Sleep medicine in neurology. John Wiley & Sons, Ltd. Chichester, West Sussex, UK.

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