An Introduction to Identifying and Treating Sleep Disorders in Adults REFERENCES/RESOURCES TOOLS & MEASURES: SLEEP DIARY: Carney, C., et al. (2012). The Consensus Sleep Diary: Standardizing prospective sleep self-monitoring. Sleep (25)2, 287-302. http://drcolleencarney.com/wp-content/uploads/2013/05/csd.pdf EPWORTH SLEEPINESS SCALE: Johns, MW (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 14(6), 540-545. http://epworthsleepinessscale.com/wp-content/uploads/2008/12/a-new-methodfor-measuring-daytime-sleepiness-the-epworth-sleepiness-scale2.pdf The Epworth Sleepiness Scale Website (MW Johns). Permissions for use of scale by individuals (clinicians & researchers) free of charge. Corporations, Institutions (including group practices) and government agencies are asked to obtain a license. http://epworthsleepinessscale.com/. Link to PDF from the website or from here: http://epworthsleepinessscale.com/epworth-sleepiness-scale.pdf INSOMNIA SEVERITY INDEX: Validation of the Insomnia Severity Index (ISI) as an outcome measure for insomnia research, Sleep Medicine, 2 297-307. Insomnia Severity Index (link to the measure): http://www.msdc.com.au/msdc/downloads_files/insomniaseverity.pdf OTHER RESOURCE/REFERENCES: Edinger, JD & Sampson, WS (2003). A primary care friendly Cognitive Behavioral insomnia therapy. Sleep, 26(2), 177-182. Link to article: http://www.journalsleep.org/articles/260209.pdf Edinger, J.D. & Carney, C.E. (2008). Insomnia: A Cognitive Behavioral Insomnia Approach. Part of the Treatments that Work series. Oxford University Press, NY. (client workbook & therapist guide) Goodie, JL, Isler, WC, Hunter, C, & Peterson, AL (2009). Using behavioral health consultants to treat insomnia in primary care: A clinical case series. Journal of Clinical Psychology, 65(3), 294-304. Perlis, M, Jungquist, C, Smith, M, & Posner, D (2005). Cognitive Behavioral Treatment of Insomnia: A Session by Session Guide. Springer. Self-Help: Carney, C.E. & Manber, R. (2013). Goodnight Mind: Turn Off Your Noisy Thoughts & Get a Good Night s Sleep. New Harbinger. Carney, C.E. & Manber, R. (2009). Quiet Your Mind & Get to Sleep: Solutions to Insomnia for those with Depression, Anxiety & Chronic Pain. New Harbinger. National Sleep Foundation Website article: Shift Work & Sleep - http://sleepfoundation.org/sleeptopics/shift-work-and-sleep
Epworth Sleepiness Scale Name: _ Today s date: Your age (Yrs): Your sex (Male = M, Female = F): How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you haven t done some of these things recently try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation: 0 = would never doze 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing It is important that you answer each question as best you can. Situation Chance of Dozing (0-3) Sitting and reading Watching TV Sitting, inactive in a public place (e.g. a theatre or a meeting) As a passenger in a car for an hour without a break Lying down to rest in the afternoon when circumstances permit Sitting and talking to someone _ Sitting quietly after a lunch without alcohol In a car, while stopped for a few minutes in the traffic _ THANK YOU FOR YOUR COOPERATION M.W. Johns 1990-97
GOOD SLEEP HABITS Sleep/Bedroom Tips: Get up at the same time each day, 7 days a week. A regular wake time in the morning will eventually help to reset your biological clock. Pick a time and stay with it, even if you didn t sleep well the night before. Sleep only as much as you need to feel refreshed during the following day. Go to bed only when you are really sleepy, and get up as soon as you wake up in the morning. Believe it or not, spending LESS time in bed actually leads to BETTER sleep! Avoid naps. Staying awake during the day helps you to fall asleep and sleep better at night. Train yourself to use the bedroom only for sleeping and sexual activity. This will teach your brain to connect your bed with sleep. Do not read, watch TV, or eat in bed. Do not try to fall asleep. This only makes the problem worse. Instead, leave the bedroom, and do something different like reading a book (but nothing TOO riveting!). Return to bed only when you are sleepy. Make sure your bedroom is a comfortable temperature, and free from light and noise. Being physically comfortable will help you wake up less during the night. Even noise that does not wake you can disturb the quality of your sleep. Carpeting, insulated curtains, and closing the door can help. A fan can help drown out external noises. Put the clock under the bed or turn it so that you can t see it. Clock watching can lead to frustration, anger, and worry. Don t take your problems to bed. Plan some time earlier in the evening for working on your problems or making a list of the next day s activities, then let yourself relax. Worrying can make it hard to fall asleep. Eating & Drinking & Smoking Eat regular meals and have a snack before bed! A light snack at bedtime (less than 200 calories) will not cause weight gain & may help sleep. Avoid greasy, spicy or heavy foods that might cause indigestion. Instead, pair a small portion of protein (8 oz. milk; yogurt or a slice of deli turkey) with a carbohydrate (3 crackers, a banana, cereal, or toast). Avoid excessive liquids in the evening and have fewer trips to the bathroom! Cut down on all caffeine products. Caffeinated beverages and foods (coffee, tea, cola, chocolate) can cause difficulty falling asleep, awakenings during the night, and shallow sleep. Even caffeine early in the day can disrupt nighttime sleep. Everybody is different; experiment to see how you tolerate caffeine. Avoid too much alcohol, especially in the evening. Although alcohol helps tense people fall asleep more easily, and it can cause you to wake up later in the night. Smoking may disturb sleep. Nicotine is a stimulant. Try not to smoke during the night when you have trouble sleeping. by the way, if you exercise
Exercise regularly. Exercise long before bedtime (at least 3 hours or more), so you aren t still wound up when you go to bed. Regular exercise can help you fall asleep and sleep more deeply. Adapted from Perlis, Jungquist, Smith & Posner (2008). Cognitive Behavioral Therapy of Insomnia (PPA Annual Conference, 6/18/14 Sue Ei, PhD)
INSOMNIA SEVERITY INDEX 1. Please rate the current severity of your insomnia problems None Mild Moderate Severe Very Severe Difficulty falling asleep 1 2 3 4 5 Difficulty staying asleep 1 2 3 4 5 Problem waking up too early 1 2 3 4 5 2. How satisfied/dissatisfied are you with your current sleep pattern? Very Satisfied Moderately Satisfied Very Dissatisfied 1 2 3 4 5 3. To what extent do you consider your sleep problem to interfere with your daily functioning (e.g daytime fatigue, ability to work/daily chores, concentration, memory, mood, etc)? Not at all A little Somewhat Much Very much 1 2 3 4 5 4. How noticeable to others do you think your sleeping problem is in terms of impairing the quality of your life? Not at all A little Somewhat Much Very much 1 2 3 4 5 5. How concerned are you about your current sleep problem? Not at all A little Somewhat Much Very much 1 2 3 4 5
6. To what extent do you believe the following factors are contributing to your sleep problem? None Mild Moderate Severe Very Severe Racing thoughts at night 1 2 3 4 5 Muscular tension/pain 1 2 3 4 5 Bad sleeping habits 1 2 3 4 5 Natural aging process 1 2 3 4 5 7. After a poor night s sleep, which of the following problems do you experience on the next day? Please circle all those that apply. a. Daytime fatigue: tired, exhausted, washed out, sleepy b. Difficulty functioning: performance impairment at work/daily chores. Difficulty concentrating, memory problems c. Mood problems, irritable, tense, nervous, groggy, depressed, anxious, grouchy, hostile, angry, confused d. Physical symptoms: muscle aches/pains, light-headed, head-ache, nausea, heartburn, muscle tension e. None
MRN: Patient Name: Date: SLEEP QUESTIONNAIRE Please answer the following questions keeping in mind your typical patterns in the past few weeks. Also, please complete the attached questionnaires (Epworth & Insomnia Severity Index). Sleep Schedule: 1. What time do you typically go to bed? 2. How long does it usually take you to fall asleep? 3. On a typical night, how many times do you wake up in the night? 4. What wakes you up during the night? 5. What time do you typically wake up to start your day? 6. How long do you usually lie in bed before you get up? 7. On days that you can sleep in, do you? YES or NO - If yes, about how long do you sleep past your normal wake-up time? 8. Do you nap? (circle) YES or NO. If yes, what time and for how long do you usually nap? 9. How do you usually feel once you are up and moving in the morning, about 15 to 30 minutes after rising? (circle) ALERT MODERATE TIRED 10. If employed, what are your typical work hours? ` Sleep Environment: 1. Where do you sleep? (circle all that apply): BEDROOM OTHER ROOM BED CHAIR COUCH FLOOR 2. Do you have a bed partner? YES or NO IF YES: -Does your partner disturb your sleep (restless, snores, etc)? YES or NO -Does your partner tell you that, during sleep, you are: restless, snore, stop breathing, talk, walk, have nightmares, or other sleep behaviors? YES or NO 3. Is your bedroom usually a comfortable temperature? YES or NO 4. Is your bedroom dark when you are trying to sleep? YES or NO 5. Is your bedroom quiet when you are trying to sleep? YES or NO 6. Is there a clock in your bedroom? YES or NO. If yes, do you watch the clock during the night? YES or NO 7. Are there animals in your bedroom? YES or NO 8. What do you do in your bedroom besides sleep and sex? (circle all that apply) TV RADIO COMPUTER READ HOBBIES PAY BILLS EAT/DRINK RELAX OTHER (describe): 9. What else would you like me to know about your sleep? Presented to PPA Conference 2014 (June 18). Sue Ei, PhD. Sueei1@gmail.com