This document discusses the negative health effects of impaired sleep, including higher cortisol and blood pressure, reduced immune function, increased cancer risk, and psychological issues. It then provides a mini sleep assessment addressing typical sleep hours, quality, and irregular sleep patterns. Risk factors for sleep apnea are listed. Poor sleep hygiene habits are outlined. Lifestyle recommendations to improve sleep include establishing a regular sleep schedule, increasing daytime light exposure, exercise, diet changes like limiting caffeine and late eating, sleep environment adjustments, and stress reduction techniques.

4. ImpairedSleep
• higher cortisol and glucose levels
• reduced insulin sensitivity
• lower daytime leptin and increase carb cravings
• elevated bp, increase sympathetic tone
• reduced peripheral perfusion
• elevated nighttime core body temperature
• less REM
• impaired learning and memory
• impaired moral judgment and misinterpretation of social cues
• decreased alertness
• melatonin and immune suppression
• increase cancer stimulating cytokines IL -10
• refractory and non-dipper HTN
• MI and coronary events
• CVD mortality
• Vasospastic disorders
• Pscyh disorders: Depression, Bipolar
Disorder, etc
• Cancer e.g. Breast, Endometrial,
Prostate, Colorectal, AML

5. MiniSleepAssessment
• Typical weekday hours of
sleep
• Typical weekend hours of
sleep
• perceived sleep quality
• <7hours duration
• 1+ hours weekday-weekend
differential
• irregular sleep timing and duration
• poor sleep quality despite 7h
• >9h
• i dont have time for sleep
Red Fl
a
gs:

6. MiniSleepAssessment
• Frequency of daytime fatigue, sleepiness &/or dif
f
iculty waking up
• Frequency & type of sleep disturbance
– Fall asleep > 8 hours before ideal wakeup time
– Sleep onset > 15-20 minutes after lights out
– Prolonged wakefulness after initial sleep onset
– Awaking < 7-8 hours after bedtime
– 2-3 nights/week suggests chronic insomnia

7. STOP:BriefOSAAssessment
• Loud Snoring
• • Often feels Tired, fatigued or sleepy during daytime
• • Others have Observed patient apnea during sleep
• • Elevated blood Pressure or taking Rx for HTN
• • < 2 positives = low risk for OSA
• • 2+ positives = high risk for OSA
• – Refer for sleep study

8. SleepHygieneAssessment
• Daytime naps > 30 minutes
• • Poor daytime hydration
• • Variations in sleep onset/offset
• • Prolonged non-sleep periods in bed
• • Stimulating activities pre-bedtime
• • Going to bed stressed, angry, upset
• • Read, watch TV, eat in bed
• • Uncomfortable bed and/or bedroom
• • Think, plan or worry in bed
• • Caffeine, alcohol within 3 hours of bedtime

9. LifestyleRxforSleep
• Use bed for sleep & sex only
• • Establish a regular schedule for bedtime & wakeup time
• • Increase bedtime peripheral cutaneous vasodilatation
– Bath/shower
– Socks or heating pad for cold feet
– Non-caffeinatedtea/beverages

10. LifestyleRxforSleep
• Increase daytime exposure to sunlight, ideally outdoors under
open sky
• • Increase daytime physical activity
– Get up and move at least once per hour
– Increase physical activity in late afternoon or early evening
• • Power naps can be bene
f
icial if limited to < 30 minutes

11. LifestyleRxforSleep:Dietary
• Eliminate nighttime caffeinated beverages
• • Limit daytime caffeinated beverages
• • Avoid alcohol within 3 hours of bedtime
• • Eliminate after dinner & late night snacking
• • Avoid high sodium foods at dinner
• • Assure adequate daytime
f
luid intake, especially late afternoon
• • Weight reduction if BMI is elevated

12. LifestyleRxforSleep:Environment
• Turn off or dim unnecessary lights atleast 1 hr before bedtime
• • Allow air temperature to gradually cool
• • Bedding to assure warm extremities
• – Socks, heating pad, blankets
• • Minimize/eliminate bedroom noise & lights
• • NoTVorcomputersinbedroom
• • Alarmclockoutofsight

13. LifestyleRxforSleep: StressReduction
• Startwindingdownatleast1hourbeforebed, include active relaxation
– Bath/shower, meditation, guided imagery, music with 60 bpm
• • Develop a wind-down routine for transitioning from daytime concerns to restfulness
– Stop work & stimulating activities 90 minutes before bedtime
• Mitigate nighttime worrying, planning, ruminating using
• Mindfulness Stress Reduction
• Cognitive Behavioral Therapy for sleep anxiety (distress when sleeping is disrupted)