Thank you to Drew University’s Health Services Department for hosting Summit Medical Group Sleep experts, Vicky Seelall, MD, FCCP, and Kerry Kelley, RN, RRT, RPSGT, for a lecture on How to Sleep Better 101. Studies have shown that seven hours of sleep is crucial for better academic performance and maintaining a higher GPA. A better night sleep in also key for improving memory retention. One way to ensure you get that beneficial shut eye, is to reduce screen time at least two hours before bed.

1. How to Sleep Better 101
Presented by:
Vicky Seelall, MD, FCCP
Kerry Kelley, RN, RRT, RPSGT

2. How to Sleep Better 101
• Basics of “Good Sleep” - Sleep Overview
• Sleep Saboteurs
 Pitfalls of Not Getting Proper Sleep
• Consequences of Poor Sleep
• How to Optimize Sleep in the College Environment
• Benefits of Getting Good Quality Sleep
 Improved college experience
 Higher GPA

3. Sleep Medicine

4. How Much Sleep is Enough?

5. Sleep and Academic Success
• Lack of sleep is identified as a significant
independent predictor of academic problems
• Factors such as stress, binge
drinking, marijuana and other illicit drug use,
which typically receive more attention by
university administrators, had similar or
relatively smaller negative associations with
academic success as compared to disturbed
sleep.

6. Dispel this Myth

7. Make this Your Reality

8. The Holy Grail
• A Good Night’s Sleep

9. Short Sleep Duration by State

10. Short Sleep in New Jersey

12. Normal Sleep Architecture

13. Sleep and Learning

14. Sleep and Learning

15. Sleep During College
• A recent study by Gaultney (2010) found that college students
were at significant risk for having sleep disorders, most notably
insomnia, and that those at risk for sleep disorders were
performing more poorly in school.
• Studies have generally found that the following are all associated
with worse academic performance in college or medical
students:
 Lower total sleep time
 Later bedtimes
 Longer sleep onset latency
 Inconsistent sleep schedules are all associated with worse
academic performance in college or medical students.

16. Factors Affecting Sleep Quality
and Quantity

18. Quality
Sleep

19. Quality
Sleep
Alcohol
Caffeine
Nicotine
Environment
Sleep
Disorders
Exercise
Parties
Study
Groups/All
Nighters
Technology
Stress

20. Sleep and Alcohol

21. Sleep and Alcohol

22. Sleep and Alcohol

23. Alcohol is a Diuretic

24. Caffeine and Sleep

25. Caffeine and Sleep

26. Caffeine and Sleep

27. Nicotine and Sleep

28. Nicotine and Sleep

29. Vaping and Sleep

30. Technology and Sleep

31. Technology and Sleep
• Blue light sends signals
to brain that inhibits
melatonin production
• All wavelengths have
this effect but blue light
more so than others
• Repeated use of bright
screen can delay the
circadian rhythm by up
to 1.5hrs

32. Technology and Sleep

33. Technology and Sleep
• Games, surfing and social media – increased
alertness and stimulation from technology activity
• Information overload that needs to be processed
before falling asleep
• Passive stimulation – listening to music, watching TV,
reading
• Active stimulation – using devices that change what
takes place of the screen according to user input

34. Technology and Sleep
• “One more chapter” becomes finishing an entire
book.
• “One more level” turns into another hour of hunting
orcs in a favorite game.
• “One more episode” becomes finishing a season
from their favorite streaming services.
• “One more text” becomes an all-night comfort
session when a friend needs a shoulder.
• “One more email” becomes a late-night work session
to iron out problems with a presentation.

35. Stress and Sleep

36. Stress and Sleep

37. Stress and Sleep

38. Exercise and Sleep
• Raises your body
temperature
• Speeds up your heart
rate
• Stimulates your nervous
system
• Exercising intensely too
close to bed can lead to
interrupted sleep

39. Environment and Sleep
• Too hot
• Too cold
• Too loud
• Too bright

40. Sleep Disorders
 Obstructive Sleep Apnea
 Restless Leg/Periodic Limb Movement Disorder
 REM Behavior Disorder
 Insomnia
 Narcolepsy

41. Obstructive Sleep Apnea

42. Risk Factors for OSA
• Personal history
• Family and ethnic risk
• Post menopausal women
Picture reference: https://utswim.wordpress.com/tag/pulmona

44. Health Affects of Untreated OSA
• Untreated OSA =
2.5x higher risk of
accidents
• Effective treatment
cuts this risk by 70%
*Risk of motor vehicle accidents is higher in people with sleep apnea. American Academy of Sleep Medicine
Tuesday, March 10, 2015

45. Preventative Strategies
• WEIGHT LOSS
 Diet, exercise, weight loss surgery
• Avoidance of alcohol
• Avoidance of prescription sleep aids
• Quit smoking!
Picture reference: http://users.rowan.edu/~blondi74/Expert.page.2.html

46. Willis-Ekbom disease
(Restless Leg Syndrome)
Diagnostic criteria:
• Urge to move (“bugs crawling up the leg”)
• Rest induced
• Gets better with activity
• Evening and nighttime worsening

47. Causes of Restless Legs Syndrome
Causes:
• Genetics (up to 50%!)
• Low iron levels
• Chronic diseases
• Pregnancy
• Kidney failure

49. REM Behavior Disorder

50. There are 84 SLEEP DISORDERS
WHICH IMPACT
100 MILLION AMERICANS
Can anyone guess the
most common sleep
complaint?

52. Insomnia
• Onset Insomnia - difficulty initiating sleep at the beginning of the night
• Maintenance Insomnia – The inability to stay asleep or those who
have difficulty returning to sleep or experience early morning
awakening.
• Comorbid Insomnia - Insomnia that occurs with another condition -
such as anxiety and depression. Certain medical conditions can either
cause insomnia or make a person uncomfortable at night (pain) which
may make it hard to sleep
• Further broken down into by duration….
 Acute/Primary insomnia – is brief – typically less than a month –
tends to be related to life circumstances.
 Chronic/Secondary insomnia – effects 3 nights/week for at least
3 months – can have many causes.
Inadequate or poor quality sleep

53. Causes of Primary Insomnia
• Significant life stress (job loss or change, death of a loved
one, divorce, moving)
• Environmental factors like noise, light, or extreme
temperatures (hot or cold) that interfere with sleep
• Interferences in normal sleep schedule (jet lag or shift work)

54. Narcolepsy
Type 1:
Narcolepsy with
cataplexy
Type 2:
Narcolepsy
without cataplexy

55. CDC Declares Sleep Disorders a
Public Health Epidemic
• According to the Centers for Disease Control and
Prevention sleep disorders are so pervasive in the
United States that they now constitute a public
health epidemic.
• Research conducted by the CDC indicates that large
numbers of Americans experience problems associated
with lack of sufficient sleep. For example:
• 23.2% of survey respondents (almost 50 million people)
reported problems concentrating during the day
• 11.3% (24 million) indicated lack of sleep interfered with
driving
• 8.6% (18 million) reported that sleep deficiency
interfered with job performance.

56. Sleep Deprivation

58. Sleep Deprivation ~ Ability to Focus

59. Sleep and Academic Performance
• 73% of college students report sleep problems.
• College students report inconsistent sleep schedules,
TST of less than 7 hours/day and lower ideal TST than
than they would choose for themselves
• 82% of them believe that too little sleep and sleepiness
impact their school performance.
• They rank sleep problems second only to stress in
factors that negatively impact academics.

60. Academic Performance Predictor
• Each day per week that a student experiences sleep
problems raises the probability of dropping a course
by 10% and lowered the cumulative GPA by 0.02
• Academic performance in college is an important
predictor of outcomes after college. For instance,
cumulative grade point average (i.e., overall average
of grades over a college career; GPA), predicts future
financial success and affects psychosocial well-
being.

61. Drowsy Driving
• National Highway Traffic Safety
Administration estimates that at
least 100,000 police reported
crashes are the direct effect of
driver fatigue
• Driving after 18 hours without
sleep is the equivalent of
consuming 2 alcoholic
beverages, driving after 24 hours
without sleep is the equivalent of
consuming 4 alcoholic
beverages

62. And while we still can’t cure the
common cold…
Getting enough sleep can help prevent catching a cold

63. Sleep Deprivation Ages You
It’s called beauty sleep for a reason…

64. Emotional Wellness

65. How to Sleep Better

66. 5 Areas to Explore
1. Environment
2. Diet
3. Exercise
4. Thoughts
5. Behaviors

67. Environment
• Surroundings
 Our environment can make a big difference to
whether we get a good night’s sleep.
 Some people can sleep anywhere at anytime but
most of us need to right conditions to fall asleep
such as quiet, darkness, comfortable bedding and
the right temperature.

68. Diet
• Avoid a heavy meal before bedtime
 Eat earlier to allow adequate time for digestion –
2-4hrs before bedtime
• Take a walk after eating
• Avoid heartburn
• Avoid late night snacking
– Leads to weight gain if high in calories
– If you are hungry – eat food that’s easily
digestible

69. Exercise
• Avoid vigorous exercise before bedtime
 Raises body temperature, speeds up heart rate
and stimulates nervous system
• Try yoga and stretching for relaxation

70. Thoughts

71. Thoughts
The vicious cycle of worrying about sleep
• Not sleeping well
• Activation of Beliefs about sleep
• I will never get enough sleep
• I need 8 hours sleep a night to function well
• Negative thoughts relating to the consequences of not sleeping
well
• I will be too tired to perform well at work tomorrow
• I will have a really bad day
• Anxiety
• Muscles tense, increased heart rate, breathing quickens
stomach ache etc.

72. Thoughts
There are two main ways out of the vicious
cycle of negative thoughts.
1. Challenging our beliefs and thoughts about sleep
If we can change our unhelpful and stressful beliefs
about sleep, then we are less likely to get anxious when
trying to sleep and sleep is more likely to happen.
2. Relaxation techniques
If we can learn how to relax our mind and body, then we
are less likely to feel anxious, and we will fall asleep
more easily.

73. Thoughts - Relaxation
• Relaxation helps promote sleep by relaxing the muscles and
calming the mind.
• Relaxation is a skill that can be learned.
• There are many relaxation techniques and it is important to find
a method which you enjoy.
• Having short times of relaxation during the day will help i.e.
going for a short walk, stretching after sitting for a long period,
adopting a relaxed posture (drop your shoulders, sit back in your
chair, relax parts of the body) and do a breathing relaxation.
• Once you can tell the difference between tension and relaxation,
you will be able to notice more quickly when you are getting
tense.
• Deal with your self-talk, particularly when you are ready to go to
sleep. Give yourself permission to switch off “Now I am going to
switch off – everything can wait till tomorrow!”

74. Thoughts - Relaxation
• Progressive muscle relaxation
 Work through the body, tensing and relaxing all the different
muscles. Do this lying down.
• Breathing
 Use the breath as a focus to calm both mind and body.
• Creative visualisation
 Many people find that mentally imagining or visualising
pleasant things is calming. Doing this sends positive
messages to the brain.
 Focusing on one subject at a time will filter out other
distractions.
 Use all of your senses and discover how to change your
imagery to make it more calming. For example pastel colours,
defocused images, and slowed motion are generally more
calming.
• Meditation

75. Problem Solving Techniques
It is helpful to put things on paper when you are either lying in bed
thinking about a problem or wake up with a problem going around in
your mind. Worry time during the day.
1. Go to a different room.
2. Write down the problem/problems you are thinking about.
3. Brainstorm all the ways you could solve the problem/problems
(don’t be practical at this stage).
4. Write down any obstacles that might get in the way of the
solution and how you might resolve these.
5. Manage your ‘self talk’ – tell yourself calmly, softly and patiently
that you have done all you can for now and will think about it
again in the morning. (90% of what we worry about never
happens and the 10% that does, we can deal with)
6. Choose the most helpful solution and write down the steps you
will need to take to achieve it.
7. Negative thinking is just a bad habit . Use positive imagery and
affirmations to help yourself feel better.
8. Relax and wind down until you are feeling sleepy again. Then
go back to bed.

76. Behaviors
Two things to keep in mind:
1. Creating patterns and behaviors that are conducive
to sleep means that we are more likely to sleep
better.
2. It is important to associate the bedroom with calm,
relaxation and sleep. If we associate our bedroom
with difficult emotions, frustration and not being
able to sleep, this causes anxiety and we go to bed
expecting not to sleep. This is a learned pattern
called conditioned insomnia. People with
conditioned insomnia often sleep better away from
home.

77. Behaviors
• Develop a ritual before bedtime to let your
body know it’s time to sleep
 Take a shower
 Drink non caffeinated tea/herbal
 Meditate
• Go to bed and wake up at same time everyday
• Try to go to bed tired by avoiding naps
• Avoid anything mentally demanding 60mins before
going to bed
• Do not smoke
• Do not drink alcohol before bed
• Avoid caffeine after 1pm

78. Behaviors
• Get up if you have not got to sleep after 20-30 minutes.
Do something relaxing, boring or repetitive to help you feel
sleepy. Then go back to bed again.
• Do not reward the body for waking up with food, drink,
cigarettes etc.
• Decide bed is for nothing other than sleeping (and making
love) so avoid eating, watching TV, telephoning, knitting,
etc.
• Avoid looking at the clock to see what time it is as this
could set off anxious thoughts about not sleeping.
• Have pen and paper at your bedside to use when thoughts
come up that you do not want to forget.
• If something is troubling you write it down before going to
bed.

79. Optimizing Sleep

80. Let’s Hear It…
If you want more A’s – Get more Zzz’s