Sleep from A to Zzzzz : Sleep Hygiene for Job Corps Students

1. Sleep from A to Zzzzz: Sleep Hygiene for Job Corps Students Valerie Cherry, PhD Lead Mental Health Specialist John Kulig, MD, MPH Lead Medical Specialist

2. After this presentation, participants will be able to: • Describe the Job Corps student's recommended sleep requirements and different types of sleep disorders in order to improve assessment and intervention on center. • Define "Sleep Hygiene" and describe at least five ways to help students improve sleep patterns in the Job Corps setting. • Utilize simple and practical cognitive behavioral strategies to help students improve sleep patterns. • Describe the options and indications for pharmacotherapy for sleep disorders. Behavioral and Medical Strategies to Help Job Corps Students Sleep

4. 12 to 18 years old: 8½ – 9½ hrs/night Adults (18+): 7½ - 8 hrs/night Sleep Requirements

5. Need an alarm clock in order to wake up on time. Have a hard time getting out of bed in the morning. Feel sluggish in the afternoon. Get sleepy in meetings, lectures, or warm rooms. Get drowsy after heavy meals. Fall asleep while watching TV or relaxing in the evening. Feel the need to sleep in on weekends. Signs of Sleep Deprivation

6. Fatigue, lethargy, and lack of motivation Moodiness and irritability Reduced creativity and problem-solving skills Inability to cope with stress Concentration and memory problems Impaired motor skills and increased risk of accidents Difficulty making decisions Reduced immunity; frequent colds and infections Weight gain Increased risk of diabetes, heart disease, and other health problems Effects of Sleep Deprivation

8. Insomnia Sleep apnea Circadian rhythm disorders Sleep Disorders

9. Inability to get the amount of sleep needed to wake up feeling rested and refreshed is the most common sleep complaint. • Often a symptom of another problem, such as stress, anxiety, depression, or an underlying health condition. • Can also be caused by lifestyle choices, including lack of exercise, substance use, medications, or even the amount of caffeine consumed. • Symptoms of insomnia include: • Difficulty falling asleep at night or getting back to sleep after waking during the night • Waking up frequently during the night • Sleep feels light, fragmented, or exhausting • Sleepiness and low energy during the day Insomnia

10. A common sleep disorder in which breathing temporarily stops during sleep due to blockage of the upper airways. These pauses in breathing interrupt sleep, leading to many awakenings each hour. • Symptoms of sleep apnea include: • Loud, chronic snoring • Frequent pauses in breathing during sleep • Gasping, snorting, or choking during sleep • Feeling exhausted after waking and sleepy during the day, no matter how much time spent in bed • Waking up with shortness of breath, chest pains, headaches, nasal congestion, or a dry throat • Assessment by center physician is indicated Sleep Apnea

12. A circadian rhythm is an internal biological clock that regulates our 24-hour sleep-wake cycle. Light is the primary cue that influences circadian rhythms. Disruption in circadian rhythms may cause grogginess, disorientation, and sleepiness at inconvenient times. Circadian rhythms have been linked to a variety or sleeping problems, including insomnia, jet lag, and shift work sleep difficulties. Abnormal circadian rhythms have also been implicated in depression, bipolar disorder, and seasonal affective disorder (the winter blues). May be an issue for Job Corps students upon arrival – sleeping during the day at home, change in time zones Circadian Rhythm Disorders

13. Time to Reboot Lol...Omg...Idk: Why am I so tired? Sleep Hygiene

14. The promotion of regular sleep is known as sleep hygiene. • Sleep hygiene is a variety of different practices that are necessary to have normal, quality nighttime sleep and full daytime alertness. • Why important? • Putting good sleep habits into practice is particularly difficult while at Job Corps and for this age group.  What is Sleep Hygiene?

15. During the day: • Limit or avoid caffeine, alcohol and nicotine • Exercise, but not too close to bedtime • Establish a regular bedtime routine • Engage in a relaxing, non-alerting activity before bedtime • Reading, Music, Meditation, Breathing Exercises • Do not drink or eat too much close to bedtime • Maintain a quiet, dark and preferably cool, but comfortable sleep environment • Keep a sleep diary to identify sleep habits and patterns. Source: National Sleep Foundation General Tips to Promote Sleep and Healthy Lifestyle

16. Does student feel safe in dorm? Is it related to health condition and/or medication? Education. Make getting enough sleep a goal like any other goal. Build a plan that helps the student focus on it and get the results they want! Relax your mind.  Avoid violent, scary, or action movies or television shows right before bed — anything that might set your mind and heart racing. Ear Plugs, headphones, and/or white noise sound app to make room quiet. Ways for Students to Have Better Sleep in Job Corps

17. Eye mask to help make room dark. Log off instant messenger, Facebook, and email. Turn off cell phone (don't just set it on vibrate) when it's time for bed. Wake up with bright light. Bright light in the morning signals your body that it's time to get going. If it's dark in the dorm room, turn on a light as soon as the alarm goes off. Ways for Students to HaveBetter Sleep in Job Corps

18. Not getting enough sleep or having sleep difficulties can: • Limit ability to learn, listen, concentrate and solve problems. • Lead to aggressive or inappropriate behavior such as yelling at friends or being impatient with center staff or family members. • Cause students to eat too much or eat unhealthy foods like sweets and fried foods that lead to weight gain. • Contribute to poor health and to visits to the Health and Wellness Center • Lead to not using equipment safely and causing accidents. Consequences for Students

19. Cognitive Behavioral Strategies

20. Focuses on changing an individual's thoughts (cognitive patterns) in order to change his or her behavior and emotional state. Interventions such as cognitive-behavioral strategies can be helpful for students who need additional support along with good sleep hygiene. Anxiety, ADHD, depression, traumatic histories, or cognitive patterns that may make it hard to fall asleep. Cognitive Behavioral Strategies to Help Students Improve Sleep Patterns

21. Expect a good night's sleep:  Instead of worrying that you won't sleep, remind yourself that you can. Say, "Tonight, I will sleep well" several times during the day. • Breathing Exercises: It can also help to practice breathing exercises before bed. • Relaxation techniques: Relaxation techniques such as progressive muscular relaxation can help sedate some people. Strategies

22. Visualizations: Picture a relaxing scene that involves sleep and build that scene in your mind. • Journal: Try keeping a diary or to-do lists. If you jot notes down before you go to sleep, you’ll be less likely to stay awake worrying or stressing. Use the note or memo feature on cell phone. • Sleep Restriction Therapy (SRT): Based on the belief that excess time in bed makes sleep problems worse. SRT consists of limiting a person's time in bed to only that time when they are sleeping. Strategies

23. A lack of sleep can often be confused with attention-deficit/hyperactivity disorder (ADHD). The most common signs of a sleep problem that are shared by ADHD include the following: • Trouble concentrating • Mood swings • Hyperactivity • Nervousness • Aggressive behavior American Academy of Sleep Medicine. (2009, March 2). Underlying Sleep Problem Linked To Attention-deficit/hyperactivity Disorder In Children. Science Daily. Retrieved August 26, 2014 from www.sciencedaily.com/releases/2009/03/090301094248.htm Sleep and ADHD

24. HERBAL/natural sleep aids Over-the-counter sleep aids Prescription drugs Pharmacotherapy for Sleep Disorders

25. Try non-pharmacological approaches first – lifestyle modification, environment, exercise. Sleep medications are for short-term use only. Principles

26. Melatonin - naturally occurring hormone that increases at night triggered by darkness – 1 mg to 3 mg taken 60-90 minutes before bedtime Valerian root – caution vivid dreams, blurred vision, changes in heart rhythm L-tryptophan – amino acid used in the formation of the chemical messenger serotonin St. John’s wort – caution drug interactions (OCPs) Chamomile tea – caution allergies Herbal/Natural Sleep Aids

27. Most contain an antihistamine • Diphenhydramine (Benadryl, Nytol, Sominex) • Doxylamine (Unisom) • Hydroxyzine (Vistaril, Atarax) – not OTC – prescription anxiolytic • Common side effects of OTC antihistamine sleep aids: • Moderate to severe drowsiness the next day • Dizziness and forgetfulness • Clumsiness, feeling off balance • Constipation and urinary retention • Blurred vision • Dry mouth and throat Over-the-Counter Sleep Aids

28. Benzodiazepine sedative hypnotics [flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion)] Non-benzodiazepine sedative hypnotics[zolpidem (Ambien), eszopiclone (Lunesta)] Melatonin receptor agonist hypnotics[ramelton (Rozerem)] Antidepressants [trazodone (Desyrel)] Prescription Drugs for Sleep

29. Physical and psychological dependence on benzodiazepines • Drug tolerance • Rebound insomnia • Headaches, dizziness, nausea, difficulty swallowing or breathing • In some cases, dangerous sleep-related behaviors such as sleep-walking, sleep-driving, and sleep-eating • New or worsening depression; suicidal thoughts or actions Prescription Drugs for Sleep: Adverse Effects

30. Sleep Hygiene Student Brochure • Health Care Guidelines for Sleep Hygiene—Coming soon! • Apps • White Noise • Breathing Exercise • Progressive Relaxation • Mindfulness Strategies • Sleep Diary/Journal Resources