1. Insomnia and poor sleep Dr Phillippa Lawson Consultant sleep physician East Anglia

2. About me Live in Saffron Walden Consultant in sleep, respiratory and general medicine at West Suffolk Hospital Founder of the good sleep programme Mother to two professors!

3. Outline What is it? Who does it affect? How is it diagnosed? What can be done?

4. What is insomnia? Difficulty falling asleep Difficulty staying asleep Early morning wakening Non-refreshing or non-restorative sleep plus Daytime symptoms Prolonged

5. Who does it affect? Anyone! Prevalence 10 – 48 % depending on study methods UK study § found incidence to be 15 %, prevalence 37% More common in females (55 %) Median age 50 years (18 – 98) Persistence of insomnia associated with increasing age Associated with mental health problems Associated with physical health problems Associated with other sleep disorders § Morphy et al SLEEP 30 (3) 2007

6. What causes insomnia? Predisposing factors Genetics Hyperarousal Depression Tendency to worry and ruminate Precipitating factors Acute stress Illness (physical or mental) Medications Worry and rumination Perpetuating factors Dysfunctional attitudes about sleep Staying awake in bed Increased time in bed Worry and rumination about insomnia

8. How do we diagnose it? Who? Self-diagnose GP Specialist in sleep medicine How?‘Sleep history’ Questionnaires Sleep diary Actigraphy Polysomnogram

9. Sleep diary example

10. How do we diagnose it? Who? Self-diagnose GP Specialist in sleep medicine How?‘Sleep history’ Questionnaires Sleep diary Actigraphy Polysomnogram

11. What can be done? Set your goals General wellbeing Nutrition and fluid intake Alcohol intake Caffeine intake Nicotine Exercise Sun light Incorporating rest times Positive attitude

12. What can be done? Preparing the sleep environment Temperature Bed and bedding Light Calm, uncluttered environment Clocks and technology! ‘Sleep hygiene’ Regular bed/rise times Avoiding napping ‘Wind down’ routine

13. What can be done? Stimulus control Get out of bed when can’t sleep Stop all sleep-incompatible activities Strengthen the bed-sleep association Sleep restriction Reduce time in bed to actual sleep time Shorten time in bed Improves sleep efficiency and strengthens bed-sleep association Avoids disrupted and fragmented sleep

14. Sleep efficiency Total sleep time (time from falling asleep to time you woke for final time minus estimated time spent awake during night) ÷ Total time in bed (time from lights out to time you finally got up) X 100

15. Sleep diary example

16. What can be done? Stimulus control Get out of bed when can’t sleep Stop all sleep-incompatible activities Strengthen the bed-sleep association Sleep restriction Reduce time in bed to actual sleep time Improves sleep efficiency and strengthens bed-sleep association Avoids disrupted and fragmented sleep

17. What can be done? Relaxation Progressive muscle relaxation/yoga/Alexander technique Breathing exercises Mindfulness Imagery Cognitive techniques Thought blocking Listing the positives Turning the tables Trying to stay awake Alternative thinking techniques Carefree attitude towards sleep Test the hypothesis Consider cognitive behavioural therapy and related techniques

18. Alternative thinking example

19. A carefree attitude towards sleep!

20. What can be done? Relaxation Progressive muscle relaxation/yoga/Alexander technique Breathing exercises Mindfulness Imagery Cognitive techniques Thought blocking Listing the positives Turning the tables Trying to stay awake Alternative thinking techniques Carefree attitude towards sleep Test the hypothesis Consider cognitive behavioural therapy and related techniques

21. But what about medication? Many on the market Frequently employed Intended as short term aid but often become long term crutch Daytime side effects Treating a symptom, not the cause Perhaps more useful as an ad hoc adjunct, for acute problems

22. Conclusion Insomnia is not a life sentence Seeking help is the first step towards moving forward The ability to succeed comes from within but gaining support will increase your chances of doing so Positive thinking is key Believe!

23. "If you think you'll lose, you're lost, For out in the world we find Success begins with a fellow's will; It's all in the state of mind. Life's battles don't always go To the strongest or fastest man; But soon or late the man who wins Is the man who thinks he can." Walter D. Wintle

24. thegoodsleepprogramme take charge, move forward, live life