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SLEEPYTIME I t s M o r e T h a n T e a a n d N e c e s s a r y f o r H e a l t h a n d W e l l n e s s Kenneth Benedik , LPC, LMFT, LAC, CCJAS, CHES Louisiana Counseling Association Conference, September 15-17, 2013 New Orleans, LA

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Louisiana Counseling Association Conference, September 15-17, 2013 New Orleans, LA

Kenneth Benedik,

LPC, LMFT, LAC, CCJAS, CHES

SLEEPYTIME

I t ’ s M o r e T h a n T e a a n d N e c e s s a r y f o r H e a l t h a n d W e l l n e s s

kjblpc@ya pc@yaho hoo.com com 337 337-23 235-2304 304

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Sp Speci cial al Th Thanks anks

Haley ey Garcia Acadian iana Brain in Injury y Center nter Jacki i Benedik, edik, MS, CHES I wi wish to acknowledg wledge the e followin

  • wing

g indiv ividuals iduals for their eir assistan stance ce in prepa paring ring this is presentation sentation:

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A LITTLE BIT OF HISTORY

  • Greeks

–Mother Night

  • Hypnos Thanos

(Sleep) (Death)

  • Alcmaecon

– Sleep is caused by blood filling the brain vessels. – Waking is caused by blood leaving the brain vessels.

  • Plato and Aristotle

– Vapors from decomposing food ran to the brain and caused sleep.

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A LITTLE BIT OF HISTORY continued….

18th & 19th Centuries

  • Findings

– Blood flowing to the head put pressure on the brain and caused sleep. – Falling asleep is a process imposed on a passive brain by the dark and quiet environment of the night time.

  • Richard Coton (1875)

– Discovery of spontaneous electrical energy in the brains of animals

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A LITTLE BIT OF HISTORY continued….

20th Century

  • Sigmund Freud (Uncle Siggy) – 1905

– The Interpretation of Dreams

  • Carl Jung - 1913

– Psychology of the Unconscious

  • Hans Burger – 1920’s & 1930

– Human person had spontaneous electrical energy that could be recorded from the scalp. (Electroencephalogram – EEG)

  • Nathaniel Klutman

– First to devote his professional life to studying sleep – 1920 first sleep lab at University of Chicago – Wrote Sleep and Wakefulness

  • Nathaniel Klutman and William Dement – 1952

– The two men meet for the first time – Nathaniel Klutman mentors and teaches William Dement

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William Dement, MD

http://www.sleepquest.com/sq_dement.shtml http://www.stanford.edu/~dement/sleepless.html http://med.stanford.edu/profiles/William_Dement/

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Dement At Stanford

  • Narcolepsy
  • Sleep Apnea
  • Sleep was not always good

–sign of depression

  • Founding of the journal SLEEP
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Ho How w Mu Much ch Sl Sleep eep Do

  • Pe

Peop

  • ple

le Ne Need ed?

AGE AMOUNT 1-4 weeks 15 ½ - 16 ½ hrs/day 1-4 months 15 ½ hrs/day 4-12 months 13 ¾ - 14 ½ hrs/day 1-3 years old 13 ¾ hrs/day 3-6 years old 10 ¾ - 12 hrs/day 7-12 years old 10 ½ hrs /day 12-18 years old 8 ½ - 9 ½ hrs/day 19+ years old 8 hrs/day

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Normal Sleep

  • fall asleep in 5-20 minutes.
  • 1-2 brief awakening per night depending
  • n age.
  • should dream every night, but may not

remember.

  • 85% - 95% of time in bed should be spent

sleeping.

  • should wake up alert, energetic and

restored after 7-8 hours of sleep.

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Normal Sleep

3 Stages of Non REM sleep 1 Stage of REM sleep

Stages

  • Stage 1 – Transition from wake to sleep

2-5% of the night

  • Stage 2 – 50% of the night
  • Stage 3 – 15-20% of the night

– Deepest level of sleep

REM Sleep

  • 15-20%
  • mostly late in the night
  • stage in which we dream
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Going To Sleep Electrical Activity in a Brain

The Promise of Sleep, pg. 19

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Essential Features

  • Sleep erects a perceptual wall between

the conscious mind and the outside world.

  • Sleep is immediately reversible.
  • Sleep is characterized by electrical

charges in the brain.

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Sleep Provides

  • Slow Wave Sleep– Restfulness
  • Rapid Eye Movement (REM)

– Defragging the brain – Dream

  • Jung

– interpretations supposed based on universal archetypes – Actually based on Western European archetypes

–Paralyzed so one cannot act out one’s dreams –Fights depression –Increases brain function

  • Clearer thinking
  • Ability to complete complex tasks
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Hormone Function

  • Growth hormone is suppressed.
  • Melatonin

– A hormone secreted by the pineal gland, a pea- size structure in the center of the brain.

  • At night melatonin is produced to help

regulate our sleep/wake cycles

  • As we age, the production decreases.
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Melato latonin nin Cycle le

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Mela lato tonin nin Secr cretio etion n to to Meas asure ure Cir ircadian cadian Ti Timing ing

Salivary Melatonin (picograms/ml) Time of Day

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Neurochemicals

  • Gamma-Aminobutyric Acid (GABA)

– Inhibitory neurotransmitter enhanced which quiets a person

  • Glutamate

– Excitatory neurotransmitter is supressed

  • Adenosine

– Signals suppression – Sleep hemostat

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Snoring

  • May be a sign of sleep apnea
  • Use a relaxation exercise
  • Do not study, do heavy reading, watch stressful TV
  • Avoid bright light in PM
  • Get into bright light in AM as oon as possible!
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Two Sleep Disorders To Be Aware Of

  • 1. Sleep Apnea
  • 2. Narcolepsy
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Sleep Apnea

  • Central:

Caused by neurological issues

  • Obstructive:

Caused by blocked airway

  • Results

– Daytime tiredness – Tachycardia (possibly leading to heart attack – Depression

  • Recognition

– Greater than size 16 neck shirt – Snoring – Daytime fatigue – Jerking at night

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Obstructive Sleep Apnea

Causes

  • Daytime fatigue
  • Depression
  • Tachycardia (which may lead to a

heart attack)

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Narcolepsy

Moving directly from AWAKE to REM SLEEP

  • Result

– FALLING ASLEEP any time, any where

  • Recognition

– Taking unwilling mini naps – Not remembering (similar to a blackout)

  • With Cataplexy

– Puddling - losing muscle control

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DSM IV-TR (Diagnostic Criteria 12 pages) SLEEP DISORDERS

  • Primary

–Dyssomnias

  • Primary Insomia
  • Primary Hypersomonia
  • Narcolepsy
  • Breathing Related Sleep Disorder
  • Circadian Rhythm Sleep Disorder
  • Dyssomnia NOS
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DSM IV™ (Diagnostic Criteria 12 pages) SLEEP DISORDERS continued…

– Parasomnias

  • Nightmare Disorder
  • Sleep Terror Disorder
  • Sleepwalking
  • Parsomnias MOS

– Sleep Disorders relation to Other Mental Disorders

  • Insomnia Related to

Axis I or Axis II

  • Hypersomnia Related to

Axix 1 or Axis II – Other Sleep Disorders

  • Sleep disorders due to a general medical condition
  • Substance Induced Sleep Disorder
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DSM 5 (Diagnostic Criteria 29 pages)

SLEEP – SLEEP WAKE 4 Divisions – 9 Divisions

  • DSM 5

–More detailed –Physiological/chemistry related

  • NB

–Sleep Medicine will be a fellowship, not just a course for MDs.

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DSM 5 (Diagnostic Criteria – 29 pages SLEEP DISORDERS continued…)

  • Sleep Wake Disorders

– Insomnia Disorder – Hypersomnolence Disorder – Narcolepsy

  • Breathing Related Sleep Disorders

– Obstructive Sleep Apnea Hypopnea – Central Sleep Apnea – Sleep Related Hypoventilation – Circadian Rhythm Sleep-Wake Disorders

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DSM 5 (Diagnostic Criteria – 29 pages SLEEP DISORDERS continued…)

  • Parasomnias

– Non Rapid Eye Movement Sleep Arousal Disorders – Nightmare Disorder – Rapid Eye Movement Sleep Behavior Disorder – Restless Legs Syndrome – Substance/Medication

  • Other Specified Insomnia Disorder
  • Unspecified Insomnia Disorder
  • Other Specified Hypersomnolence Disorder
  • Unspecified Hypersomnolence Disorder
  • Other Specific Sleep-Wake Disorder
  • Unspecified Sleep Wake Disorder
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Essential Sleep Hygiene

  • Do not work out just before bed time.
  • Go to bed when you are sleepy.
  • Keep naps to a minimum – 30 minutes before 2

pm MAX!

  • Keep bedtime snacks very light
  • Do not smoke at bed time.
  • Keep a regular sleep schedule.

– Same time to retire – SAME TIME TO RISE!

  • If you are sleepy, go to bed earlier.
  • DO NOT SLEEP LATER!
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Bibliography

  • Benedik, K, Benedik, J. Sleep Issues With Adolescents

(Lafayette, LA, LCA conference, 2004)

  • Brown, K, Hall, JM Effects of Age and Alcoholism on Sleep

(www.ncbi.nlm.nih.lgov/pmcl/articles/pmc2981610)

  • Dement, William C. Vaughan, Christopher The Promise of Sleep

(NY. Random House, 1999)

  • Doghrami, Karl, The Effects of Alcohol on Sleep

(www.medscape.org/view_article1497982 )

  • DSM IV-TR
  • DSM 5
  • Roehrs, T., Roth T. Sleep, Sleepiness and Alcohol Use.

(http://pubs.niaaa.nih.gov/publications/arh25-2/101-109.html )