K R I S T E N W R I G H T F N P - C , C A N Y O N V I E W W O M E N ’ S C A R E

A D J U N C T F A C U L T Y B Y U C O L L E G E O F N U R S I N G

CATCH YOUR 2ND WIND: FATIGUE & SLEEP ISSUES

VIDEO CLIP, BIG HERO 6

OBJECTIVES:

•  Review the prevalence and impact of fatigue

•  Identify the main causes of fatigue

•  Discuss the normal sleep cycle

•  Understand how stress & aging affect sleep

•  Give practical advice to improve sleep & energy

Sleepiness

Impaired arousal &

tend to fall asleep

Feel better after a nap

Fatigue

Lack of energy

or motivation

Mental Exhaustion

Poor endurance

& delayed recovery

Nonrestorative sleep

1:3 adolescents have fatigue at least 4 days per week

1:5 patients have fatigue

DROWSY DRIVING

1500 fatalities/year 40,000 non-fatal injuries/year

EFFECT ON ECONOMY

Lose 2 hrs. sleep

1 night

2 to 3 beers

Costs > $63 billion/year in lost productivity

“Sleep is private behavior that has public consequences.”

- Russell Sanna, Division of Sleep Medicine, Harvard Medical School

“…insufficient sleep is a public health epidemic”

- Centers for Disease Control

sleep

SICK

FAT

STUPID

And see that all these things

are done in wisdom and order; for it is not requisite that a man should

run faster than he has strength. And again, it is expedient that he

should be diligent and thereby he might win the prize; therefore, all things must be done

in order.

-Mosiah 4: 27

HOW DID WE GET SO TIRED?

UNDERSTANDING SLEEP

Two-Process Model of Sleep Regulation

SLEEP CYCLING

75-80%

20-25%

REM SLEEP

• Bursts of rapid eye movement • Dreaming • Muscle atony (relaxed) • Provides energy to brain & body •  Supports daytime performance •  Important for learning &

memory consolidation

NON-REM SLEEP

•  Deepest and most restorative sleep •  Blood supply to muscles increases •  Tissue growth and repair occurs •  Energy is restored •  Blood pressure drops •  Breathing becomes slower •  Muscles are relaxed •  Hormones are released

•  growth hormone, essential for growth and development, including muscle development

HOME CARE

•  Get enough rest

• Eat a healthy diet

HOME CARE

•  Get enough rest •  Eat a healthy diet

• Exercise regularly

HOME CARE

•  Get enough rest •  Eat a healthy diet •  Exercise regularly

• Learn to relax

RELAXATION EXERCISE

•  Feet & toes •  Calves/lower legs •  Thighs •  Buttocks •  Abdomen •  Lower back (arch) •  Chest (hold in deep breath) •  Hands (fists) •  Upper arms •  Shoulders (shrug) •  Face (squeeze eyes and purse lips)

Allow 10 to15 seconds between

each muscle group before

going to the next. Begin with feet and move up:

TIPS FOR THE WORRIER:

Right before bed -write down exactly what’s currently going on in your head -must write every single word! -more conscious, concrete

1 hour before bed

-make a to do list for tomorrow -must write -use legal pad -go to sleep

LIST TO DE-STRESS

•  Kegel exercises (hold 20 seconds) •  Diaphragmatic breathing: stretch (lay down, arms

above head) •  Sequential muscle relaxation •  A good cry •  Deep breathing •  Avoid dehydration •  Acute stress, 10 min of exercise •  High intensity light therapy

HOME CARE

•  Get enough rest •  Eat a healthy diet •  Exercise regularly •  Learn to relax

• Reasonable schedule (at work and home) •  Take multivitamin •  Avoid alcohol, nicotine, drug use •  Sleep Hygiene

I think sleep took me

off its friend list, blocked me and removed me…

and now I’m getting

a friend request from insomnia.

I wish I could sleep….

HOME CARE

•  Get enough rest •  Eat a healthy diet •  Exercise regularly •  Learn to relax •  Reasonable schedule (at work and home)

•  Take multivitamin • Avoid alcohol, nicotine, drug use •  Sleep Hygiene

• Consistency • Calming & ritual • Get up & try again

avoid clock-watching!

• Bedroom for sleeping & intimacy • Avoid naps • Cool room •  Sleep diary

SLEEP HYGIENE

• Consistency • Calming & ritual • Get up & try again

avoid clock-watching!

• Bedroom for sleeping & intimacy • Avoid naps • Cool room • Sleep diary

SLEEP HYGIENE

TEMPERATURE

http://yoursleep.aasmnet.org/pdf/sleepdiary.pdf

DEEP SLEEP DISRUPTORS

• Medical conditions & illness •  Anxiety & depression •  Sleep apnea and restless leg

•  Medications •  Substance use

•  Pain •  Frequent urination •  Menopause •  Gastric reflux •  Pregnancy

WARNING SIGNS

• Dizziness or confusion • Blurry vision • Abrupt swelling, weight gain or no urine •  Thought of self harm • Unexplained weakness or fatigue • Unintentional weight loss • Wake up and can’t fall asleep • Persistent headaches

MEDICAL WORK UP

• Physical Examination •  lymph nodes, heart murmur, enlarged thyroid,

swelling, poor muscle tone, neurologic changes

•  Laboratory work •  CBC, CMP, ESR, TSH, HIV, Hcg, TB, Lyme titers, etc.

•  Imaging •  chest X-ray, ultrasound

•  Specific testing •  ECG, ECHO, PFT, EEG

•  Sleep study

DEEP SLEEP DISRUPTORS

•  Medical conditions & illness •  Anxiety & depression •  Sleep apnea and restless leg

• Medications •  Substance use

• Pain •  Frequent urination •  Menopause •  Gastric reflux •  Pregnancy

ENERGY DRINKS

•  Caffeine is the main ingredient in energy drinks

•  Sports drinks contain electrolytes, sodium, K helpful for rehydration

=

REDUCE OR ELIMINATE DRUGS THAT NEGATIVELY IMPACT SLEEP

X

nicotine, alcohol, narcotics, tranquilizers, caffeine

LIGHT

MELATONIN

AMBER GLASSES

must block out 90% of blue light. Most only block 10%,

DEEP SLEEP DISRUPTORS

•  Medical conditions & illness •  Anxiety & depression •  Sleep apnea and restless leg

•  Medications •  Substance use

•  Pain

• Frequent urination • Menopause • Gastric reflux • Pregnancy

PATTERNS WITH AGING

CHANGES WITH AGING

MEDICATIONS

•  Over the Counter •  Antihistamines (Benadryl, Unisom) •  Melatonin •  Valerian

•  Benzodiazepines •  Ativan, Valium

•  Non-benzodiazepines •  Lunesta, Sonata, Ambien (CR)

•  Antidepressants (doxepin, Trazadone, amitriptyline) •  Antipsychotics (Seroquil)

•  Cognitive Behavior Therapy

OVER THE COUNTER No regulation, so no guarantee about what the supplement contains (active ingredients or unintentional ingredients) no proof of effectiveness.

•  http://www.informationisbeautiful.net •  http://www.nutritional-supplement-truths.com/Vitamin-

supplement-manufacturers.html •  http://www.nutritional-supplement-truths.com/

nutritionalvitaminsupplements.html •  http://www.drwhitaker.com/choosing-the-best-

supplements-to-take •  http://www.consumerreports.org/health/free-highlights/

manage-your-health/supplements_questions.htm

THANK YOU!

handouts at canyonviewwomenscare.com

RESOURCES

•  http://www.cdc.gov/Features/dsSleep/index.html •  Fatigue: An Overview, American Family Physician •  Sleep Physiology Sleep Disorders and Sleep Deprivation

from the NIH •  Fatigue, Medline Plus •  Treatment of Insomnia, UpToDate •  Sounding the Alarm on Sleep, Readers Digest •  Management of Common Sleep Disorders, American

Family Physician •  Pathophysiology: The Biologic Basis for Disease in Adults

& Children by Kathryn McCance and Sue Huether •  http://sleepfoundation.org/