Sleep Management: How to Advise Patients
Published: 11 July 2019
Published: 11 July 2019
Sleep: it’s not the passive activity it may seem, but a distinct time for processing information and for restoration.
Our bodies need long periods of sleep in order to restore and rejuvenate, to repair tissue, grow muscle and synthesise hormones, among other important processes (National Sleep Foundation 2019).
It is worth emphasising the importance of sleep to your patients. Sleep deprivation will not only hinder the healing process, but may introduce other significant health problems into their lives (NIH 2019; Better Health 2018; National Sleep Foundation 2019).
An obvious sign that a patient is not getting sufficient sleep is that they complain of waking up feeling tired, and that this feeling continues into the day.
They may also be sleep deficient if they express the urge to sleep while engaging in relaxing activities such as watching television, riding in a car or talking with a friend (NIH 2019).
We each have an internal ‘body clock’ that determines when we’re awake and when our body requires and subsequently, is ready for, sleep.
The body clock has a 24-hour repeating rhythm known as the circadian rhythm.
Two processes occur to control this rhythm:
(National Sleep Foundation 2019; NIH 2019)
If a patient regularly misses out on sleep, or if their sleep is of poor quality, the sleep loss adds up. The total sum of sleep lost is referred to as their sleep debt. If they lose three hours of sleep each night, they’ll have a sleep debt of 21 hours at the end of the week (NIH 2019).
Sleep is a vital part of the body’s healing process and crucial to the reparation of the heart and blood vessels.
Patients are to be advised that repeated sleep deficiency has been associated with a heightened risk of heart disease, kidney disease, high blood pressure, weight gain and stroke (NIH 2019).
The damage from sleep deficiency could occur in an instant, for example, in a car crash or injury as a result of a lapse of concentration. It is estimated that sleep deprivation causes one in every six road accidents. (Better Health 2018) Sleep deficiency can also build up to cause long-term issues for the patient.
Sleep also affects how the body reacts to insulin, the hormone that controls our blood glucose level. Sleep deficiency results in a higher than normal blood sugar level, which may increase a patient’s risk for diabetes (NIH 2019).
Additional physical symptoms include: bodily fatigue, poor coordination, impaired judgement and delayed reaction time (NIH 2019; Better Health 2018).
In addition to raising the risk of some chronic health problems, sleep deprivation also has several alarming mental side-effects. It can affect how a person thinks, feels, learns, and is able to get along with others (Better Health 2018; NIH 2019).
Consequences relating to sleep deprivation include: trouble making decisions, solving problems, controlling emotions and behavior, and coping with change (NIH 2019).
Frighteningly, sleep deficiency also has been linked to depression, suicide, and risk-taking behaviour. Studies also show that sleep deficiency can affect activity in some parts of the brain. Sleep helps us pay attention, make decisions, and aids our capacity for creativeness (NIH 2019).
In children, these effects tend to be even more evident and may display as difficulties getting along with others; anger and impulsive behaviours, mood swings, feelings of sadness or hopelessness, or a lack of motivation. Children may also have problems paying attention and appear stressed (NIH 2019).
The term ‘sleep hygiene’ refers to our habits and practices around sleep. We need to remind patients that when we become busy, sleep isn’t the first thing we should sacrifice.
Encourage that your patients have set times that they go to bed and wake up every day. Good habits start when we’re young, therefore children will greatly benefit from a set bedtime and a bedtime routine (NIH 2019).
Patients should maintain their sleep schedule on weeknights and weekends. If possible, they are to keep the difference between weekday and weekend rising-time to no more than about an hour.
Remind patients that staying up late and sleeping in on weekends will throw off their body clock (NIH 2019).
The hour before going to sleep should be a restful time with few stimulants.
Strenuous exercise immediately before bed is to be discouraged. Bright and artificial light, such as from a TV or computer screen is to be avoided as the light may signal to the brain that it's time to wake up (NIH 2019).
Patients may find that a nighttime routine helps to prepare them for sleep. This may include things such as taking a bath before bed, stretching, or reading a book.
Any non-stimulating activity that can be practised regularly before bed is suitable (National Sleep Foundation 2019).
Tell patients to try to avoid heavy and/or large meals within a couple of hours of bedtime, (though a light snack is okay). It is known that heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks can trigger indigestion (National Sleep Foundation 2019).
Alcohol is to be avoided before bed, as is nicotine (for example, cigarettes) and caffeine (including caffeinated soda, coffee, tea, and chocolate). Nicotine and caffeine are stimulants, and both substances can interfere with sleep. The effects of caffeine can persist for as long as eight hours (NIH 2019).
Spend time outside every day and be physically active. It has been shown that even as little as 10 minutes of aerobic exercise can improve our quality of sleep, so even a short walk around the block may make a difference (National Sleep Foundation 2019).
Keep your bedroom quiet, cool, and dark. Wear earplugs if noise is an issue. Recommend that patients limit bedroom activity to sleep and intimacy, so that the brain associates the space with sleep as opposed to work or entertainment (National Sleep Foundation 2019).
Advise patients to write down how much they sleep each night, how alert and rested they feel in the morning, and how sleepy they feel during the day. They can then relay this information to a GP or sleep expert (NIH 2019; National Sleep Foundation 2019).
The most widely recognised causes of sleep deprivation include parenthood, shiftwork, illness, poor sleeping habits, the use of certain drugs, medications and late-night usage of TV, the internet and social media – people who fall into one or more of these categories should monitor their sleep habits and ensure that they are not exposing themselves to the risks of sleep deprivation (Better Health 2018).
Shiftwork is commonplace in healthcare and workers often find it challenging to keep to a regular sleep schedule. Shiftworkers often find there is not enough time between each shift to sleep and spend time with friends or family before they have to get ready for their next shift.
Naps are not a substitute for sleep but may be useful when time is limited. It may also be useful to talk to other workers about how they are able to cope with sleep loss (Better Health 2018; National Sleep Foundation 2019).
The following can be considered as forming the grounds for a diagnosis of insomnia:
Interestingly, in an American study, it was found that the most common comorbidities linked to insomnia were psychiatric disorders. The study found that in an estimated 40% of all insomnia patients had a coexisting psychiatric condition. Among these psychiatric disorders, depression was the most common, and insomnia was a diagnostic symptom for depressive and anxiety disorders (Roth 2007)
Sleep shouldn't be an after-thought when it comes to good health. Good sleep is linked to countless health benefits and the lack of it is known to cause significant short-and long-term problems.
Make rest a priority for your patients, and be sure to extend that care to yourself as well.
Question 1 of 3
True or False: 40% of all insomnia patients had a coexisting psychiatric condition
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