IMPACT OF BEHAVIOUR ON SLEEP Flashcards
THE EPWORTH SLEEPINESS SCALE
- The Epworth Sleepiness Scale is used to diagnose obstructive sleep apnoea (OSA) (but can be use generally to assess sleepiness)
Use the following scale to choose the most appropriate number for each situation:
0 = would never doze 1 = slight chance of dozing 2 = moderate chance of dozing 3 = high chance of dozing
Situations:
Sitting and reading
Watching TV
Sitting still in a public place (e.g. a theatre, a cinema or a meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when the circumstances allow
Sitting and talking to someone
Sitting quietly after lunch without having drunk alcohol
In a car or bus while stopped for a few minutes in traffic
Scores can be interpreted as follows:
0-5 lower normal daytime sleepiness 6-10 normal daytime sleepiness 11-12 mild excessive daytime symptoms 13-15 moderate excessive daytime symptoms 16-24 severe excessive daytime symptoms
10 and above may require further attention
THIS SCALE DOESN’T PROVE OR DISPROVE THAT YOU HAVE A SLEEP-RELATED PROBLEM AS MANY FACTORS CONTRIBUTE TO EXCESSIVE SLEEPINESS, AND THIS IS JUST AN INDICATION OF WHETHER FURTHER INVESTIGATION IS REQUIRED
SLEEP HYGIENE AND SLEEP HEALTH?
Sleep hygiene is a variety of different practices that are necessary to have a normal, quality night’s sleep and increase daytime alertness.
Sleep health takes into account quality, quantity and timing – including its regularity – of sleep in addition to vulnerability towards poor sleep and the impact of sleep on daytime functioning. Sleep hygiene is important for everyone, no matter their age, in order to promote healthy sleep and daytime alertness. Good sleep hygiene can also prevent the development of sleep disorders such as insomnia.
The Sleep Charity has produced guidelines that are simple to follow and shows how making a few changes to your routine over a 24 hour period can make a huge difference to your wellbeing. Name some:
Morning routine
Keep a regular sleep/wake schedule
Keeping regular hours helps the body’s sleep system stay in harmony and promotes feelings of sleepiness and drowsiness when your body is ready for sleep. Therefore, where possible, wake up at the same time each morning and go to bed at the same time every night.
Get out into natural light as soon as is practical in the morning, preferably around the same time every day
Natural light, which can still be effective on a cloudy or grey day, helps reset our internal body clock. It helps us get over feeling groggy when we have just woken up and makes us more alert.
Daytime routine
Engage in daytime exercise
Exercise promotes the quantity and quality of your sleep, making it deeper and more refreshing. However, a few studies have shown that exercising too close to bedtime can prevent sleep so we suggest leaving a window of at least 2 hours before bedtime without exercise.
Avoid stimulants that contain caffeine 8 hours before bedtime
Although there are significant individual differences in how caffeine affects each of us, give yourself enough time between your last caffeine intake and your sleep time to make sure that it does not interfere with your ability to get off to sleep.
Evening routine
Don’t go to bed full, hungry or thirsty
Eating at regular times helps strengthen our internal body clock. However, eating a heavy meal before bedtime can make it challenging to sleep at night. Drinking lots of liquid before bed will also increase the chances that we have to go to the bathroom during the night. Conversely, being hungry or thirsty at night can increase the chances of waking up. A balance should be struck between being sated but not full up before we go to bed.
Reduce electronic use before bedtime and avoid electronic use in the bedroom
Using electronics just before bed and in the bedroom can keep us awake for longer as the blue light from these devices has the capacity to prevent the hormones that make us sleepy from being produced. Importantly, it is not just the light that can affect our sleep but most activities that we use our devices for can keep us awake and alert which we don’t want to do at bedtime.
Don’t use alcohol to sleep
Although alcohol is a sedative, it can have a significant impact on the quality and quantity of your sleep. Our sleep tends to become fragile and light when we have a lot of alcohol in the evening and can lead to lots of awakenings in the latter part of the night and feelings of being unrefreshed during the day.
Nighttime routine
Avoid nicotine before bed
Nicotine is a short-acting stimulant that can keep you awake and so should be avoided in the later part of the evening and during the night if you happen to wake up.
Ensure the bedroom is cool, dark and quiet before bed
Heat, light and noise can impact on our ability to get off to sleep and increase the chances that we wake in the night. Even if we don’t realise that is the reason for us being awake. Making sure the bedroom is cool, dark and quiet can improve the quality of our sleep as can sleeping on a comfortable, supportive bed.
Ensure that bedroom clocks are not visible
It is common to watch the clock when we are awake at night. For some of us, this can increase our anxiety levels and further prevent us from being able to fall asleep. It is not necessary to remove the clock, as, for example, some people rely upon their alarm clocks to get them up in the morning, but having the clock face out of sight will help reduce any sleep anxiety.
What is the most powerful cue for shifting the phase or resetting the time of the circadian clock?
Light
IMPACT OF SCREEN TIME BEFORE SLEEP?
Studies indicate that screen time before bed can increase the amount of time it takes to fall asleep, reduce sleep quality, and affect attentiveness the following day. In the long term, nightly exposure to light in the evening may increase the risk of certain sleep disorders and cancers.
Bright evening light 2 hours before bedtime will shift the time for sleep later, so you will tend to get sleepy and fall asleep later in the evening and will wake up later in the morning.
Do you know which hormone is primarily released by the pineal gland at night, and has long been associated with control of the sleep–wake cycle?
MELATONIN
Blue light and melatonin?
Exposure to blue light from mobile phone phones, tablets, fluorescent lighting, and even the TV suppresses the production of melatonin, a hormone that induces sleepiness. This is actually an advantage during the day because it keeps you feeling alert and refreshed.
Bright morning light will shift the time for sleep earlier, so you will tend to get sleepy and fall asleep earlier in the evening and will wake up earlier in the morning.
However, melatonin release in the evening helps you relax before bedtime. Suppression of melatonin can cause you to stay up later and sleep less than you normally would.
HOW TO REDUCE BLUE LIGHT EXPOSURE IN THE EVENING?
The most effective way to reduce exposure to blue light in the evening is to simply turn off the sources. This means dimming or reducing LED and fluorescent lighting and turning off electronic devices after it gets dark outside.
Specialty glasses may also be helpful in reducing exposure to blue light. While they may not work for everyone, blue-light-blocking or amber glasses can reduce the melatonin-suppressing effects of bright light.
Since many people can’t simply turn off sources of blue light after it gets dark, here are a few other ideas to reduce blue light exposure that may be interfering with your sleep.
Make it a routine: Set an alarm that reminds you to turn off electronics 2 to 3 hours before bedtime.
Find a better lamp: If you like to read in bed, try getting a lamp that doesn’t emit blue light. Red or orange lamps work well, as does natural lighting like candles.
Learn to dim: Find out if you can dim the brightness on your electronic devices or if they have a “night mode” that reduces the emission of blue light.
Try an app: If you need to use devices before bed, try out one of several smartphone and computer applications that can help reduce blue light emission or turn on night-time mode if your phone or computer has this feature..
Improve your sleeping environment: If there are light sources in your bedroom that you can’t dim or turn off, try using an eye mask to block them out once you’re in bed.
Chronotype
Chronotype and Circadian Preference
Chronotype is a personality-like trait in which humans are categorized according to their daytime preference, their wake and bedtimes, or their midpoint of sleep on days off. According to the current state of research, chronotype is divided into either demarcated types (morning type, evening type, or neither type or determined by a score on a continuum. As a personality trait, it refers to the preferred daytime for physical or cognitive activities, thereby indicating the particularly efficient periods. Morning-oriented people reach their peak performance in the morning while evening-oriented people show their best performance in the late afternoon. Chronotype differs from sleep duration by its inherent trait of timing that is irrelevant to the length of sleep. In the current study, we view chronotype as a unidimensional construct with a parametric score.
