Good Night (slide share edition)


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  • Sleep disturbance is a national problem
  • 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.
  • Lunesta is the only hypnotic approved for >35 days useSide efcts memory, nightmares behavioral addicition
  • To make a change
  • At 200 am can be really cold for others or with sheet kickers
  • Good Night (slide share edition)

    1. 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. 2. Dr RicWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    3. 3. The First Health ApproachWe didn’t invent the practice of medicine…. we’re just changing the way it’s provided.
    4. 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. 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. 6. National Institute of Health• Creation of - National Center of Sleep Disorders Research 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. 7. The Cycle
    8. 8. Evening Roller Coaster
    9. 9. Circadian Rhythm DisordersExtrinsic • Delayed Sleep Phase Syndrome • Advancement of Sleep Phase Syndrome • Irregular Sleep-Wake Pattern • Non-24Hour Sleep Phase SyndromeIntrinsic • Shift Work Sleep Disorder • Jet Lag
    10. 10. Problems DX’d in Hospital• Obstructive Sleep Apnea• Restless Leg Syndrome• Nocturnal Myoclonus(Periodic Limb Mvmt Dis)
    11. 11. Sleep lab
    12. 12. OSA
    13. 13. TX’d w/ Surgery or Appliance
    14. 14. Problems DX’d in Office All other
    15. 15. Sleep Diary
    16. 16. 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)
    17. 17. Spokes in the “Wheel of Wholeness”
    18. 18. One “Spoke of the Wheel” that is easy to fixSleep
    19. 19. Circadian Rhythm
    20. 20. The 5 sense rule• Sight• Sound• Smell• Touch• Taste 5 Simple Ways to Effect a Change
    21. 21. 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.
    22. 22. Fooling Nature’s Rhythm • Illinois Coalition for Responsible Outdoor Lighting • Chicago’s Department of Environment Protect Migrating BirdsKeep City Light Away from Nature Keep Highway Light Away From Homes
    23. 23. 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
    24. 24. Smell• Aroma therapy to entrain RR• Herbalist blending• Get food away
    25. 25. 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
    26. 26. Touch• Comfort feel• Loose feel• Textiles for temperature profile (ayurveda) He = Hot She= Cool
    27. 27. Temp and Season • American Academy of Sleep Medicine • 68-72*(personal comfort) • Cool initiates sleep …but may freeze out others. Like living in a caveGoing through the Change
    28. 28. Eat• Timing• Reflux/cough• Hormonal stim (G.I.)• Ayurveda’s time clock
    29. 29. 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)
    30. 30. The B word (Behavioral Health) • MSW • LPC, LCPC • PsyD • PhD • APRN • MD, DOUnderlying Behavioral Conditions if not Addressed willLead to Failure in Making a Change
    31. 31. 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)
    32. 32. Man YogaNorthwest Community Hospital Wellness Center 2010 South Arlington Heights Road Arlington Heights, IL Phone: 847-593-3330