Good Night
            Staging Restful Sleep




             Enrique Saguil, M.D.
We didn’t invent the practice of medicine….
                we’re just changing the way it’s provided.
Dr Ric

We didn’t invent the practice of medicine….
                we’re just changing the way it’s provided.
The First Health Approach




We didn’t invent the practice of medicine….
                we’re just changing the way it’s provided.
Your Community
     of Care

      Ric Saguil, MD
    Jason Gruss, MD
  Debbie Stamm, NP
     Tom Jordan, RD
 Katrina Christie, LCPC
  Jennifer Green, ND
   Joe Musolino, DC
  Emery Paredes, PT
   Aimee Weber, EP
   Yu Zhu, MD China




      You
Stats
•   50-70 Million Americans suffer sleep or circ disrdr
•   15% population affected by sleep disordered breathn
•   1 in 20 RLS
•   1 in 5 Chronic Insomnia
•   20% population exposed to shift work schedule (> chance)


                            International Classification of Sleep Disorders 2nd ed
                            Diagnostic and Statistical Manual of Mental Disorders
National Institute of Health
• Creation of -
   National Center of Sleep Disorders Research
                     http://www.nhlbi.nih.gov/about/ncsdr/index.htm


-70% adults insufficient sleep/rest 1xm
-11% adults insufficient sleep/rest daily
-Short and Long sleep duration assoc w obesity,
   DM, HBP, Stroke, Depression, Subs Abuse (2 fold)
-Assoc 20% MVA Crash injuries

                                           Exxon Valdez
The Cycle
Evening Roller Coaster
Circadian Rhythm Disorders
Extrinsic


  •   Delayed Sleep Phase Syndrome
  •   Advancement of Sleep Phase Syndrome
  •   Irregular Sleep-Wake Pattern
  •   Non-24Hour Sleep Phase Syndrome
Intrinsic

  • Shift Work Sleep Disorder
  • Jet Lag
Problems DX’d in Hospital


• Obstructive Sleep Apnea
• Restless Leg Syndrome
• Nocturnal Myoclonus(Periodic Limb Mvmt Dis)
Sleep lab
OSA
TX’d w/ Surgery or Appliance
Problems DX’d in Office



       All other
Sleep Diary
TX’d with Pharmacy
                      To
•   Lunesta        initiate
                    Sleep
•   Sonata
•   Ambien
•   Rozerem                                       To Stay
                                                  Asleep
•   Halcion (BZ)              •   Lunesta
                              •   Ambien CR
                              •   Restoril (BZ)
                              •   Prosom (BZ)
                              •   Doxepin (TCA)
Spokes in the “Wheel of Wholeness”
One “Spoke of
         the Wheel”
        that is easy to
               fix




Sleep
Circadian Rhythm
The 5 sense rule

• Sight
• Sound
• Smell
• Touch
• Taste    5 Simple Ways to
           Effect a Change
Light
• Close the curtains


• Block the indirect light


• Change the ipad to blue


• Let the sun shine in the morning not at night!
             We didn’t invent the practice of medicine….
                             we’re just changing the way it’s provided.
Fooling Nature’s Rhythm
  • Illinois Coalition for Responsible Outdoor
    Lighting
  • Chicago’s Department of Environment



                                                                 Protect Migrating Birds




Keep City Light Away from Nature

                                   Keep Highway Light Away From Homes
Sound
• Create an environment starting
              2 hours before sleep
• White noise machine/fan/vapor
• Sleep apnea machine (for him)
• Ear plugs (for her)
• Spare bedroom (sleep 1st Aid)                Metallica is good for Battle




                  Mozart has a calming effect with the Brain
Smell
• Aroma therapy to entrain RR
• Herbalist blending
• Get food away
Allergic Rhinitis
•   Nasal irrigation
•   Hydrate
•   Vacuum and dust 2x week or more In season
•   Include curtains and use HEPA filters
•   Replace mattress (>5 years)
•   Cover mattress, pillows dust mite resistant case
•   Humidify or dehumidify P the area of house
•   Allergy shots? +/-
•   Benedryl/Claritin/Zyrtec
Touch

• Comfort feel
• Loose feel
• Textiles for temperature profile (ayurveda)




                           He = Hot   She= Cool
Temp and Season
    • American Academy of Sleep Medicine
    • 68-72*(personal comfort)
    • Cool initiates sleep …but may
                    freeze out others.
                                             Like living in a cave




Going through the Change
Eat
•   Timing
•   Reflux/cough
•   Hormonal stim (G.I.)
•   Ayurveda’s time clock
TX’s with Nature

•   5HTP          Night
•   Melatonin             •   Rhodiola         Day
•   Valerian/hops         •   Caffeine
•   Passionflower         •   Light therapy
•   Skullcap              •   High protein day
•   Ashwaganda            •   High carb night
•   Breath (RR)           •   Exercise (ForF)
The B word (Behavioral Health)
    •   MSW
    •   LPC, LCPC
    •   PsyD
    •   PhD
    •   APRN
    •   MD, DO


Underlying Behavioral Conditions if not Addressed will
Lead to Failure in Making a Change
The Saguil Approach
•   Understand Rhythm                          Night

•   Cut Caffeine/Decrease Fluids
•   Ritualize Bedtime for at least 21 days straight
•   Herbs (melatonin/valerian with hops)
•   Aromatherapy
•   Lights out/chill out
•   BAM
                               • Light up the day      Day
•   Journal 3 positives
                               • Rhodiola
                               • Music (Metallica)
Man Yoga
Northwest Community Hospital Wellness Center




    2010 South Arlington Heights Road
           Arlington Heights, IL
          Phone: 847-593-3330
     www.FirstHealthAssociates.com

Good Night (slide share edition)

  • 1.
    Good Night Staging Restful Sleep Enrique Saguil, M.D. We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
  • 2.
    Dr Ric We didn’tinvent the practice of medicine…. we’re just changing the way it’s provided.
  • 3.
    The First HealthApproach We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
  • 4.
    Your Community of Care Ric Saguil, MD Jason Gruss, MD Debbie Stamm, NP Tom Jordan, RD Katrina Christie, LCPC Jennifer Green, ND Joe Musolino, DC Emery Paredes, PT Aimee Weber, EP Yu Zhu, MD China You
  • 5.
    Stats • 50-70 Million Americans suffer sleep or circ disrdr • 15% population affected by sleep disordered breathn • 1 in 20 RLS • 1 in 5 Chronic Insomnia • 20% population exposed to shift work schedule (> chance) International Classification of Sleep Disorders 2nd ed Diagnostic and Statistical Manual of Mental Disorders
  • 6.
    National Institute ofHealth • Creation of - National Center of Sleep Disorders Research http://www.nhlbi.nih.gov/about/ncsdr/index.htm -70% adults insufficient sleep/rest 1xm -11% adults insufficient sleep/rest daily -Short and Long sleep duration assoc w obesity, DM, HBP, Stroke, Depression, Subs Abuse (2 fold) -Assoc 20% MVA Crash injuries Exxon Valdez
  • 7.
  • 8.
  • 9.
    Circadian Rhythm Disorders Extrinsic • Delayed Sleep Phase Syndrome • Advancement of Sleep Phase Syndrome • Irregular Sleep-Wake Pattern • Non-24Hour Sleep Phase Syndrome Intrinsic • Shift Work Sleep Disorder • Jet Lag
  • 10.
    Problems DX’d inHospital • Obstructive Sleep Apnea • Restless Leg Syndrome • Nocturnal Myoclonus(Periodic Limb Mvmt Dis)
  • 11.
  • 12.
  • 13.
    TX’d w/ Surgeryor Appliance
  • 14.
    Problems DX’d inOffice All other
  • 16.
  • 17.
    TX’d with Pharmacy To • Lunesta initiate Sleep • Sonata • Ambien • Rozerem To Stay Asleep • Halcion (BZ) • Lunesta • Ambien CR • Restoril (BZ) • Prosom (BZ) • Doxepin (TCA)
  • 19.
    Spokes in the“Wheel of Wholeness”
  • 20.
    One “Spoke of the Wheel” that is easy to fix Sleep
  • 21.
  • 22.
    The 5 senserule • Sight • Sound • Smell • Touch • Taste 5 Simple Ways to Effect a Change
  • 23.
    Light • Close thecurtains • Block the indirect light • Change the ipad to blue • Let the sun shine in the morning not at night! We didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
  • 24.
    Fooling Nature’s Rhythm • Illinois Coalition for Responsible Outdoor Lighting • Chicago’s Department of Environment Protect Migrating Birds Keep City Light Away from Nature Keep Highway Light Away From Homes
  • 25.
    Sound • Create anenvironment starting 2 hours before sleep • White noise machine/fan/vapor • Sleep apnea machine (for him) • Ear plugs (for her) • Spare bedroom (sleep 1st Aid) Metallica is good for Battle Mozart has a calming effect with the Brain
  • 26.
    Smell • Aroma therapyto entrain RR • Herbalist blending • Get food away
  • 27.
    Allergic Rhinitis • Nasal irrigation • Hydrate • Vacuum and dust 2x week or more In season • Include curtains and use HEPA filters • Replace mattress (>5 years) • Cover mattress, pillows dust mite resistant case • Humidify or dehumidify P the area of house • Allergy shots? +/- • Benedryl/Claritin/Zyrtec
  • 28.
    Touch • Comfort feel •Loose feel • Textiles for temperature profile (ayurveda) He = Hot She= Cool
  • 29.
    Temp and Season • American Academy of Sleep Medicine • 68-72*(personal comfort) • Cool initiates sleep …but may freeze out others. Like living in a cave Going through the Change
  • 30.
    Eat • Timing • Reflux/cough • Hormonal stim (G.I.) • Ayurveda’s time clock
  • 31.
    TX’s with Nature • 5HTP Night • Melatonin • Rhodiola Day • Valerian/hops • Caffeine • Passionflower • Light therapy • Skullcap • High protein day • Ashwaganda • High carb night • Breath (RR) • Exercise (ForF)
  • 32.
    The B word(Behavioral Health) • MSW • LPC, LCPC • PsyD • PhD • APRN • MD, DO Underlying Behavioral Conditions if not Addressed will Lead to Failure in Making a Change
  • 33.
    The Saguil Approach • Understand Rhythm Night • Cut Caffeine/Decrease Fluids • Ritualize Bedtime for at least 21 days straight • Herbs (melatonin/valerian with hops) • Aromatherapy • Lights out/chill out • BAM • Light up the day Day • Journal 3 positives • Rhodiola • Music (Metallica)
  • 34.
    Man Yoga Northwest CommunityHospital Wellness Center 2010 South Arlington Heights Road Arlington Heights, IL Phone: 847-593-3330 www.FirstHealthAssociates.com

Editor's Notes

  • #7 Sleep disturbance is a national problem
  • #10 Intrinsic – Jet lag, or Shift work sleep disorder (SWSD). Jet lag can occur when one travels to different timezones. SWSD affects those individuals who normally need to work at different times, and whose sleep cycle is constantly changing. Extrinsic – There are four types: delayed sleep phase syndrome (DSPS), advancement of sleep phase syndrome (ASPS), irregular sleep-wake pattern and non-24 hour sleep-wake syndrome. The condition called DSPS commonly occurs among teens. Most teens make it a habit to sleep late and thus end deprived of sleep. ASPS is more common among older people, and it causes unwanted awakening and excessive drowsiness. Sleep-wake pattern is when a person has a very irregular sleep schedule and non-24 hour sleep-wake syndrome occurs when a person sleeps later as each day passes.
  • #18 Lunesta is the only hypnotic approved for >35 days useSide efcts memory, nightmares behavioral addicition
  • #23 To make a change
  • #30 At 200 am can be really cold for others or with sheet kickers