now go to sleep! sleep disorders in suds & recovery fully rested - gets up easily not sleepy...
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1Now Go To Sleep!Sleep Disorders In SUDs & Recovery
Fully Rested -
Gets Up Easily
Not Sleepy During Day
Good Mood
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Now Go To Sleep!Sleep Disorders In SUDs & Recovery
3Now Go To Sleep!Sleep Disorders In SUDs & Recovery
________________-Chemical messenger in the brain by which messages are carried bet neurons.
_________________ are created in the ____________ cell then released in amts large enough cause __________ effect on another ____.
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Now Go To Sleep!Sleep Disorders In SUDs &
Recovery
STEPHANIE F. CHARLES LPC, NCC, CCDP-D, ACS
SPECTRUM HEALTH SYSTEMS, INC
AUGUST 2015
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Sleep Disorders In SUDs & RecoverySleep Rewards
#1
Operational Functioning
Effectiveness
#2
Transforms experiences into
long-term memories
#3
Resupply previously used
neurotransmitters
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Now Go To Sleep!Sleep Disorders In SUDs & Recovery
Sleep & Wellness
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Now Go To Sleep Sleep Disorders in SUDs & Recovery
Sleep Expenses
Approx 70 million exper sleep loss/sleep disorders
$16 billion in healthcare $50 million lost productivity Most unrecognized & not treated Deep sleep is restorative sleep
stage & nec for energy & rest Not “down time”
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Sleep Disorders In SUDs & RecoveryWhat Are They1. Insomnia
Sleep onset (initial insomnia)-diff initiating sleep at bedtime Sleep maintenance (middle insomnia)-frequent night
awakenings or prolonged awake periods Late insomnia-early morning periods of awakenings and diff
returning to sleep Diff staying asleep common symptom
2. Hypersomnolence
3. Narcolepsy
4. Breathing-related
5. Circadian Rhythm Sleep-Wake
6. Non-Rapid Eye Movement (NREM) sleep arousal
7. Nightmare
8. Rapid Eye Movement (REM) sleep behavior
9. Restless Leg Syndrome
10. Substance/medication-induced
9Now Go To Sleep!
Sleep Disorders In SUDs & RecoveryInsomnia
Most prevalent sleep DO
Daytime impairments
Nighttime difficulties
More common in women
Common comorbid DO in many medical conds (bi-directional)
Treat both if comorbid conds
Monitor sleep quality & daytime sleepiness during & after withdrawal
Can be symptom or independent DO
Frequently observed comorbid with med cond or mental DO
40%-50% present with comorbid mental DO
Likely occurrence when predisposed indiv exposed to precipitating event
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Now Go To Sleep!Sleep Disorders In SUDs & Recovery
Insomnia
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Now Go To Sleep!Sleep Disorders In SUDs & Recovery
So What’s The Problem?
Sleep problems in SUDs
Can occur during withdrawal
Can last for years
High prevalence of sleep disturbances in Substance Use Disorders (SUDs) in contrast to general population
35.3% less than 7 hrs sleep in 24-hr period
48.0% Snore
37.9 unintentionally fall asleep during the day
Comorbid disorder that may lead to:
Self medication
Tranquilizers to sleep
Stimulants to stay awake
Other Sleep disturbances
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Now Go To Sleep!Sleep Disorders In SUDs & Recovery
Associated with
Depression
Anxiety
Cognitive changes
Persistent sleep disturbances (insomnia & excessive sleepiness) risk factors for
Dev of mental illnesses
Substance use DOs
Should be addressed
Management
Tx planning
Differential Dx
Clinical indicator for
Coexisting medical & neurological in depression & common mental DOs
Coexisting conds rule—not the exception
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Sleep Disorders In SUDs & RecoveryPrimary Dissatisfactions
Quality (non-restorative) Incomplete sleep cycles 60-120 mins per cycle Five phases per cycle
Sleep-mind at rest, breathing slows, eyes closed, images—still conscious
Rest, closed eyes
Light sleep
REM or dreaming
Signaling end of cycle
Quantity 6-7 hrs
10.3 when daytime cues removed
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Sleep Disorders In SUDs & Recovery…but how much & why?
Indicator of health & overall well-being
Humans – 1/3 of life spent sleeping
Sleep debt common reality
Sleep varies across age spans
Sleep complicators Energy drinks
External lighting
Electronic lights
Alarm clocks
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Sleep Disorders In SUDs & Recovery …but how much & why?
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Sleep Disorders In SUDs & RecoveryGetting To Sleep…But How
Bedtime ritual: Bed same time
nightly Up at same time
daily Avoid sleeping in
Avoid: Caffeine
Alcohol
Nicotine
Meals:
Don’t skip any meals
Avoid heavy meals before bed
Exercise-but avoid strenuous activity before bed
Soothing music
Turkey and milk to induce drowsiness
Warm shower or bath
Lavender oil on pillow
Cup of herbal Chamolile
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Now Go To Sleep!Sleep Disorders In SUDs &
RecoveryCaffeine
Most popular stimulant worldwide
Stimulates dopamine
85% Americans substantial daily consumption (per person approx. 20 lbs yrly)
Caffeine-induced sleep DO – insomnia that is dose-dependent (e.g. daytime sleepiness)
Found in
Cocoa
Chocolate
Cola Drinks (primarily extracted from decaffeinating coffee)
Tea (more caffeine than coffee but consumed less)
OTC (decongestants, bronchodilators, analgesics, alertrness aids, diuretics, appetite suppressants, menstrual pain preparations)
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Sleep Disorders In SUDs & Recovery CaffeineWithdrawal
Sleep problems
Throbbing headache prominent symptom
Sleepiness
Fatigue
Depression
Decreased alertness
Irritability
Symptoms can be seen in newborns of mothers who consume 200-1800 mg per day
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Sleep Disorders In SUDs & Recovery
Caffeine Stimulates CNS- Acts as antidepressant
Elevate serotonin Elevate dopamine Counters anti-depressants
Inhibits calming Can lead to output of more adrenalin
Nervousness Jitters Trembling Irritability
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Sleep Disorders In SUDs & Recovery Caffeine
Adenosine blocker (depresses mood, induce sleep, anticonvulsant properties, slows heart rate, dilates blood vessels)
Low dose mild stimulant--Increase alertrness
Dissolve drowsiness or fatigue
Help thinking
3-4 cups (about 350 mg per day)
Encourage anxiety & panic attacks
Insomnia
Gastric irritation
Nervousness
May lower fertility rates in women
May increase risk of miscarriage in women
Errors
Commission—from excessive arousal—results in typos
Omission—affects more complex, unfamiliar—eg. concentration
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Now Go To Sleep!Sleep Disorders In SUDs & Recovery
Caffeine
Average how much?
100 mg normal effective range
10 g – lethal dose (approx. 67 cups)
Half-life 3-7 hrs. Body rids of 95% about 15-35 hrs.
Coffee
Drip 150 mg
Percolated 100 mg
Espresso 100 mg
Instant 50 mg
Decaf 2 mg
Tea
(brewed 1 min) 10-30 mg
(brewed 5 min) 20-50 mg
Iced tea (70) mg
Energy Drinks
80 mg
5-hr 207 mg
OTC
Excedrin 130 mg
Dependence-400-500 mg per day
Arousal – per cup, lasts approx. 6-12 hrs
Milder dependence than (amphetamines, cocaine)
Relapse can occur after stopping use
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Caffeine Can Prime Addiction Seeking-Behaviors
Impacts Learning, Memory, Cognitive Functioning
&
Crutch for Inadequate Sleep
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Sleep Disorders In SUDs & RecoveryCaffeine
Impacts on Recovery
Physical, mental, & emotional
Subst use generally precipitates or accompanies insomnia in those who are vulnerable
Decrease in level of energy
Mood disturbances
wired
Interferes with treatment process
Significant influence in alcohol relapse
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Best
Avoided
by those
vulnerable
to
addictions
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Now Go To Sleep!Sleep Disorders In SUDs &
Recovery Alcohol
Stimulant (low to moderate use & depressant drug-higher doses and when BAC declines.
Extensive effect on daytime sleepiness & sleep
Insomnia, other sleep disturbances, e.g breathing, in AUDs.
Hormones:
Pituitary (growth & milk production in women.
Neurochemicals-CNS functioning. GABA- generates new nerve signals.--Lowers inhibs & slows brain procesess. Mental confusion, mood swings, loss of judgment, & high emotionality
Glutamate-Release stimulates & reinforces drinking
Suppresses REM sleep
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Now Go To Sleep!Sleep Disorders In SUDs &
RecoveryAlcohol
Low doses-enhance neurotransmitters GABA & adenosine-encourage sleep
Interferes with deep-sleep stages in second half of night
Liver breaks down alcohol
No longer activate sleep neurotransmitters
Tolerance develops to sedating effect & disrupts sleep
Other effects
Trigger adrenaline
Diuretic effects
Sleep
Relaxes throat muscles
Disrupts other brain mechanisms
Leads to snoring
Other breathing problems
Inaccurate-exaggerated reporting of sleep patterns
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Now Go To Sleep!Sleep Disorders In SUDs & Recovery
Nicotine CNS stimulant—interferes with neurotransmission of
Acetylcholine—affects sleep
Reduced sleep efficiency
Decreased daytime sleepiness
Higher rate of smoking when sleep is 6 hrs or less
18-44 yoa higher smoking rate if sleep 6 hrs or less
Can impair attention, concentration & cognitive abilities
Stimulates & Calms
After continued use—effect more assoc w/prev nicotine withdrawal
Withdrawal
May exper nocturnal awakenings caused by tobacco cravings
Increases relapse potential
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Now Go To Sleep!Sleep Disorders In SUDs & Recovery
Sleep Penalties
Interpersonal, personal, & occupational potential effects: Increased daytime irritability Decrease in attention &
concentration (accidents) Assoc w/long-term myocardial
infarction Absenteeism Reduced work productivity Overall reduced quality of life Subsequent economic liability
Cognitive abilities e.g.- attention, decision making, and executive functioning degrade significantly after extended periods of wakefulness
Sleep Disorders elevates the expectation of gains and diminishes the effects of one’s losses following risky decisions.
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Sleep Disorders In Addiction & Recovery Reasons For Change
Quality of life issue First step in having
control of your own life Do it for yourself Not always easy to
create & initiate Difficult at times Do it for you!
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Chronic Alcohol User –
After abstinence
Sleep disturbances may continue
weeks,
Months,
Years
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Now Go To Sleep!Sleep Disorders In SUDs & Recovdery
Good Sleep Varies person-to-person No next day excessive
fatigue
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Now Go To Sleep!Sleep Disorders In SUDs & Recovery
Sleep Architecture
Same time daily for going to bed & getting up
Naps—short & before 5:00 pm
Keep bedroom relaxing-avoid working in bed
Wind down before going to bed—establish a routine
Room temperature--not to hot or cold
Sleep in complete darkness Melatonin-Neurotransmitter assoc w/sleep
Inhibited by light
Encouraged by darkness
Exercise regularly--releases calming neurotransmitters
Finish exercise at least 2-4 hrs prior to bedtime
Bed only for sex & sleep
Don’t eat or drink to much close to bedtime
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Steer Clear
Keep TV out of bedroom Watching the clock Busywork Computer/games Eating/family hang out Healthy partner relationship-
don’t go to bed angry Meals & snacks high in-
proteins, fats & carbs
Foods that encourage heartburn—spicy, peppermint, onions, fatty
Fluids at least two (2) hrs before bed
Caffeine at least six (6) hrs before bed
Smoking 3-6 hrs Alcohol at least three (3) hrs Don’t lie awake in bed-after 20
mins—get up & do something non-stimulating
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Now Go To Sleep!Sleep Disorders In SUDs & Recovery
Fully Rested - Gets Up Easily
Not Sleepy During Day Good Mood
Stephanie F. Charles LPC, NCC, CCDP-D, ACS
678-565-0665