The Guide to Better Sleep Naturally. written by Anne-Marie Foster, BS, RRT for the Sleep Management and Consultation Center

Transcription

1 The Guide to Better Sleep Naturally written by Anne-Marie Foster, BS, RRT for the Sleep Management and Consultation Center

2 Foreword Sleep is a wave and you are a surfer. Every night your goal is to catch the perfect wave and enjoy a nice long ride straight through till morning. For most people, that perfect wave rolls in sometime between 10 and 11 pm every night. With that in mind, you the surfer, must be ready to catch that wave and must be in tune with your body to recognize that it is coming. If you miss that perfect wave, another wave will be around in an hour or so, but it won t be as well-formed and won t give you as smooth and as long a ride. The perfect wave will have you asleep in 5 minutes and bring you a good 7 to 8 hours of solid sleep, with nearly half of it in the important sleep stages of Delta and REM. It will bring you to shore feeling refreshed and ready for your day.

3 The Guide to Better Sleep Naturally Written by Anne-Marie Foster, BS, RRT for The Sleep Management and Consultation Center All rights reserved Respiratory Repository, LLC Box 5 Old Mystic, CT sleepynomore@areyou-sleeping.com

4 Table of Contents Introduction 5 Chapter 1 Establish your level of daytime 7 sleepiness Chapter 2 Determine your daytime alertness 9 peaks and troughs Chapter 3 Identify or rule out sleep disorders 11 caused by physical causes Chapter 4 Analyze and adjust your body's 15 natural rhythms Chapter 5 Calculate your individual sleep 18 need Chapter 6 Change some habits to improve 20 your sleep hygiene Chapter 7 Recognize which medications can 24 interfere with sleep Chapter 8 Use exercise to enhance natural 29 sleep Chapter 9 Use light therapy to enhance 30 natural sleep Chapter 10 Create a healthy bedtime routine 31 Conclusion 32

5 REM = 20-25% INTRODUCTION Stage 1 = 10% Delta = 15-20% Stage 2 = 50% Normal Sleep A normal sleep cycle is about 90 minutes long and is made up of five stages: stage 1 = drowsiness with light dreams stage 2 = light sleep stages 3 & 4 = Delta or deep sleep stage 5 = REM or deep dream sleep Delta = 10-15% REM = 0-10 % Stage 2 = 30% Stage 1 = 50% Abnormal Sleep

6 The 90 minute sleep cycle usually repeats itself 4-6 times a night, but not always in a linear fashion. In normal sleep, you may reach your first REM stage 60 to 90 minutes after you fall asleep, having gone from stages 1 to 2 to Delta to REM. This Delta stage may last 10 to 15 minutes & this REM stage may be very short. In your next cycle, you may skip stage 1 entirely and go straight to stage 2, then to a slightly longer Delta stage, a short REM stage, etc. In normal sleep, Deltas are longer during the first third or half of the night and REMs are longer during the last half of the night, particularly between 3 am and 6 am. Sleep is classified as abnormal if there is inadequate time spent in the deep sleep stages of Delta and REM. This lack of deep sleep is why people feel tired. Sleeping for 8 hours does not guarantee you will feel rested if you have not spent enough of those 8 hours in Delta & REM sleep. Although it is unclear why we require enough REM sleep, it is clear why Delta sleep is so important. During Delta sleep, the body restores muscle, tissue, bone & blood cells that have been damaged, destroyed or died of old age and releases and/or produces hormones that regulate many of the vital functions of the body. If this repair, replacement, restoration & release does not take place, it weakens the immune system, and as a result, over time, a lack of deep sleep leaves you more prone to getting sick. In abnormal sleep, you may never get into REM sleep at all. If you do, you will dream, but may not remember them. If you happen to wake up during REM, you may remember your dream, but unless you focus on it or write it down, by morning, the memory of the dream will most likely have faded. In sleep disrupted by a sleep disorder, there may be two to three cycles before Delta and/or REM sleep is reached. The more severe the daytime sleepiness, the more likely it is that REM is never reached. Certain medications are known to cause a delayed onset of Delta or REM sleep or even total REM suppression. As mentioned previously, if Delta and REM sleep are not achieved, sleep is pretty much a waste of time.

7 CHAPTER 1 ESTABLISH YOUR LEVEL OF DAYTIME SLEEPINESS To do this, fill out the Epworth Sleepiness Scale that follows. The higher your total, the more urgent it is that you read and follow the advice in this guide, get profesional advice in the form of a personalized Sleep Plan (you ll find an order form on the last page of this guide) or go to a sleep professional in your area. Excessive daytime sleepiness should not be ignored. It is estimated that there are 100,000 motor vehicle accidents in this country every year caused by drowsy drivers and that more teenagers are killed by drowsy driving than by drunk driving. The Epworth Sleepiness Scale that follows rates how sleepy you are during the daytime. You may have become so used to being tired all the time that you think it is normal. Or you may be in denial or have lowered your expectations about ever feeling well rested again. EVERYONE deserves and CAN GET better sleep naturally, without drugs. Your score on the Epworth Sleepiness Scale will tell you how sleepy you are (and therefore how badly you are sleeping) according to the international sleep experts. Answer the questions as honestly as you can. Rate how likely it is that your eyelids will droop, you'll feel yourself "nod off" or you'll actually fall asleep DURING THE DAYTIME during the eight activities listed below. As you follow the suggestions in this guide, repeat the Epworth test to track your improvement. NOTE: Even if you haven't been in some of these situations, just guess how they might affect you.

8 EPWORTH SLEEPINESS SCALE Use the following selections to choose the most accurate answer for each situation: 0 = would never doze 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing Situation Chance of dozing (0-3) 1. Sitting and reading 2. Watching TV 3. Sitting quietly in a public place, i.e. movie theater, conference room 4. As a passenger in a moving car for an hour without a break 5. Lying down in the middle of the afternoon 6. Sitting and talking to someone 7. Sitting quietly after a lunch without alcohol 8. As the driver of a car, while stopped in traffic for a few minutes. Total Add up your score. A total score of 6 or more suggests you suffer from daytime sleepiness. 10 or more suggests excessive daytime sleepiness (EDS). 16 or more suggests dangerously excessive daytime sleepiness.

9 CHAPTER 2 DETERMINE YOUR DAYTIME ALERTNESS PEAKS AND TROUGHS The next step is to use the scale that follows to figure out the times of your highest & lowest peak operating efficiency. STANFORD SLEEPINESS SCALE (MODIFIED) 1) Feeling energetic, alert, wide awake 2) Still functioning at high levels, but not peak; still able to concentrate 3) Awake, but mellowing; responsive, but not fully alert 4) Becoming unable to focus or concentrate; more relaxed; less alert 5) Unable to concentrate, losing interest in remaining awake; slowing down 6) Woozy, fighting sleep; would prefer to be lying down 7) No longer fighting sleep, eyelids are drooping; having dream-like thoughts X) Just waking up or falling asleep Y) Asleep Fill in the number or letter from above that most clearly matches the description of your level of alertness on an average day at the times below: Time of day Sleepiness Rating (1-7, X, Y) 6 am 7 am 9 am 11 am 1 pm 3 pm 5 pm 7 pm 9 pm 11 pm midnight total (add the 1-7 responses) (a) divide (a) by the # of 1-7 responses (b)

10 Referring back to the previous ratings: 1) What was your average sleepiness rating for the day? (b) 2) Most everyone has two peak times of alertness daily, most commonly 9 am and 9 pm. When were your peak alertness times? (ratings of 1) and 3) There are also generally two times of low alertness, but usually only night shift workers are aware of experiencing the second one. The average low times tend to be around 3 pm and 3 am. When were your lowest alertness times - other than bedtime? and Using the answers from above, try and schedule your days to capitalize on those highs and lows. Attempt to schedule all important decisions, meetings, presentations, etc. during your times of peak alertness and avoid scheduling activities that require a clear head during the lows. Repeat this test occasionally as you make adjustments to your sleep habits and schedules to continually maximize your operating efficiency.

11 CHAPTER 3 IDENTIFYING OR RULING OUT SLEEP DISORDERS THAT HAVE PHYSICAL CAUSES Excessive daytime sleepiness has many, many causes. You need to identify and / or rule out sleep disorders that have physical causes. Take the following Quick Sleep Screening Test to see if your symptoms are suggestive of any of the dozen or so sleep disorders that the test screens for. Two or more true statements in each category indicate that you have symptoms of the sleep disorder listed in italics and suggest that you look into a more definitive diagnosis either by talking to your doctor or ordering our home Sleep Evaluation. It is not unusual to have one true answer in a number of categories; having many individual symptoms can disrupt your sleep yet not point to a specific sleep disorder. Continue reading; the suggestions yet to come may well fix your symptoms & help you find & ride that perfect wave. Place an "X" in front of any statements that are true. My family & friends say I have become grumpy & irritable. I have less energy than I used to. I could easily take a nap before dinner. I have trouble concentrating. Excessive daytime sleepiness I ve been told that I snore/snort/stop breathing when I sleep. I ve been told that I thrash about a lot when I sleep. I usually make more than 2 trips to the bathroom at night. I sleep propped up on 2 or more pillows. Obstructive sleep apnea

12 I often worry that I will have trouble falling asleep. I often lie awake in bed for more than 20 minutes at a time. I often wake up after a few hours of sleep & have trouble getting back to sleep. I often have trouble turning off my thoughts while trying to fall asleep. Insomnia I have less energy than I used to have. I have less energy than I want to have. I rarely look forward to getting up in the morning. I have memory and/or concentration problems. Depression I tend to be a perfectionist. I tend to be a workaholic. I often wish there were more hours in a day. I have trouble sleeping because I'm worrying about what I have to do the next day. Anxiety or stress Sometimes I wake up with a sore throat. Sometimes I get daytime heartburn. Sometimes I get heartburn while lying in bed. Sometimes I wake up choking. Heartburn or reflux disease I often wake up with achy legs. I often wake up with sore leg muscles. I have been told that I kick at night. I have been told that my arms or legs jerk when I am sleeping. PLMS (periodic limb movements in sleep)

13 I get creepy, crawly sensations in my legs during the day. I get creepy, crawly sensations in my legs when trying to sleep. I can't keep my legs still at night; I must move them to feel comfortable. I must get up & walk around at night to make my legs feel comfortable. Restless leg syndrome I often wake up with a dry mouth. At least twice a month, I wake up during the night coughing. At least twice a month, I wake up during the night gasping or short of breath. At least twice a month, I wake up wheezing or with a tight feeling in my chest Nasal or sinus issues, asthma, or lung disease I am unable to stay awake past 8 or 9 pm. I am unable to fall asleep before 1 or 2 am. If I don't go to bed by 10 pm, I'm not sleepy again until after midnight. I work the night shift. Circadian rhythm disorder I have slept through the phone ringing. I can sleep 10 to 12 hours every night. No matter how much I sleep during the night, I still feel sleepy during the day. I have trouble keeping a job because I am always late for work. Hypersomnia

14 I often feel overwhemingly sleepy during the day even after a full night's sleep. I fall asleep when I do not want to, such as while eating, talking, driving or working. I find that I am briefly unable to talk or move while I am falling asleep or waking up. Sometimes when I'm laughing, surprised, angry or afraid I feel my muscles go limp. Narcolepsy I have been told that I grind my teeth while sleeping. I have been told that I walk in my sleep. I have been told that I talk in my sleep. I have woken up screaming in fear. Parasomnias Again, it is not unusual to have one true answer in a number of categories. These multiple individual symptoms can disrupt your sleep, yet not point to one specific sleep disorder. Continue reading; the suggestions yet to come may well fix your symptoms & help you find & ride that perfect wave. If two or more statements in any category are true, it is suggestive of the listed sleep disorder. To learn how to get better sleep naturally, without drugs, order the Take-Home Sleep Evaluation, an individualized, professional evaluation in the comfort of your own home, or talk to your doctor or a sleep specialist in your area.

15 CHAPTER 4 ANALYZING AND ADJUSTING THEIR BODY'S NATURAL RHYTHMS. The next step is to analyze your body's natural rhythm, which is best done with the aid of a sleep log. Answer the following questions and then, over the course of a week or two, fill out the log that follows to document your answers. Use the sample log that follows it to fill out the blank log. Are you a morning lark or a night owl? Are you a short sleeper or a long sleeper? Do you find it difficult to get going in the morning? Do you find yourself getting sluggish around 2 to 3 pm? Do you often feel the need for a nap before dinner? Do you get an added burst of energy at 9 or 10 pm? Do you find it difficult to get to sleep before 1 or 2 am? Do you wake up at 3 or 4 am & have trouble getting back to sleep? Does your teenager not want to go to bed until midnight or later and then want to sleep in every weekend til noon? Do you find yourself playing catch up by sleeping in on weekends? Do you sleep better when you are away from home?

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18 CHAPTER 5 CALCULATING YOUR INDIVIDUAL SLEEP NEED This section requires a bit of a time commitment on your part, but is key to you getting better sleep naturally. Set aside a block of time, possibly as long as two weeks, when you can sleep for as long as 10 to 12 hours a night, if necessary. With any luck, one work week, plus the two weekends on each end, is all it will take to discover your true sleep need. You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

19 You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

20 CHAPTER 6 IMPROVING YOUR SLEEP HYGIENE Improving your sleep hygiene has very little to do with cleanliness. It has to do with habits, both good and bad; what you put into your body, sometimes for as long as to 4 to 6 hours before bedtime; and your sleeping environment or what you put your body into at bedtime. Everyone is different and has their own personal sensitivities, so these are just guidelines that you must adjust for yourself. Some contain repeats for emphasis: Sleep Tip #1. GET OUT OF BED AT THE SAME TIME EVERY MORNING. No matter how late you went to bed. And no catching up on weekends or while on vacation!! It helps to keep your circadian rhythm (internal clock) running on time & that helps make you sleepy at bedtime. Sleep Tip #2. AVOID NAPS. Do something active or distracting: talk on the phone, go for a walk, clean the bathroom. IF SLEEP THREATENS TO OVERCOME YOU, NAP FOR NO MORE THAN AN HOUR AND NEVER AFTER 3 PM. While for some, a "power nap" can be very rejuvenating, for others, even a short nap will re-set their circadian clock and make it harder for them to go to sleep and stay asleep all night. You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

21 You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

22 You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

23 You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

24 CHAPTER 7 RECOGNIZING THE MEDICATIONS WHICH CAN INTERFERE WITH SLEEP Learning to recognize which medications can interfere with sleep involves careful reading. CHECK THE FINE PRINT on prescription drugs, over the counter medicines, vitamins, minerals, herbal preparations, etc. Insomnia is a VERY COMMON side effect of many substances, some of which are actually prescribed "off-label" for sleep. If you suffer from excessive daytime sleepiness and take any of the substances on the following pages, ask your doctor about switching you to a drug in the same chemical class that doesn't have insomnia or another sleep disturbance as a side effect. There are many medications that can prevent you from catching and riding that perfect wave. Here is a breakdown of commonly prescribed drugs that have insomnia as a side effect: You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

25 You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

26 You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

27 You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

28 You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

29 CHAPTER 8 USING EXERCISE TO ENHANCE NATURAL SLEEP Good old-fashioned fresh air and exercise will help you fall asleep faster and get deeper, more consolidated sleep (fewer awakenings or arousals.) In addition, exercise has been known to decrease the symptoms of Restless Leg Syndrome (RLS) and Periodic Limb Movements in Sleep (PLMS). As with anything that has the potential to affect your circadian rhythm, you should follow a regular schedule for exercise. You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

30 CHAPTER 9 USING LIGHT THERAPY TO ENHANCE NATURAL SLEEP Light can be used to enhance natural sleep by helping to get you and your internal clock onto the schedule you want to be on. Bright light therapy (2,500-10,000 Lux via a light box) has been found to be useful for people suffering from Seasonal Affective Disorder (SAD) to help them re-set their internal clock and therefore their circadian rhythm. For smaller shifts in your internal clock, you can use natural sunlight or house lights: You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

31 CHAPTER 10 CREATING A HEALTHY BEDTIME ROUTINE The final drill is to create a bedtime routine that you follow faithfully EVERY NIGHT to send the signal to your body and mind that "SURF'S UP!" and it s time to get ready to catch that perfect sleep wave. Until you are in that sleep groove, if at all possible, this routine should be done every night, without fail, to slow you down and set the tone for sleep. You need to order The Guide To Better Sleep Naturally to view the rest of this chapter.

32 CONCLUSION If your surfing technique still needs a little help, there are additional training methods to help you, such as behavior modification and sleep restriction therapy. They generally involve individual assessment and follow up, including one-on-one assistance such as that available through our Personalized Sleep Analysis or with a qualified sleep professional in your area. If you choose to order our Personalized Sleep Analysis, you will receive an in depth questionnaire probing your medical history, your sleep history as well as your sleep related patterns and habits. Your responses will be analyzed by a health care professional with over twenty five years experience in breathing and sleep disorders and you will receive her recommenda- tions in the form of a detailed action plan designed to help you get better sleep, naturally. An order form can be found on the web site. Keep in mind that change takes time, but that a good night's sleep is worth it!