Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Learning materials
Therapy for Clients With Pain and Sleep/Wake Disorders
Learning Objectives
Students will:
• Assess client factors and history to develop personalized therapy plans for clients with sleep/wake disorders
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for sleep/wake disorders Therapy for Clients With Pain and Sleep/Wake Disorders Essay

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• Evaluate efficacy of treatment plans for clients presenting for sleep/wake therapy
• Apply knowledge of providing care to adult and geriatric clients presenting for sleep/wake disorders
Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings

https://ezp.waldenulibrary.org/login?url=https://stahlonline.cambridge.org/

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.
• Chapter 11, “Disorders of Sleep and Wakefulness and Their Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:
For insomnia
• alprazolam
• amitriptyline
• amoxapine
• clomipramine
• clonazepam
• desipramine
• diazepam
• doxepin
• flunitrazepam
• flurazepam
• hydroxyzine
• imipramine
• lorazepam
• nortriptyline
• ramelteon
• temazepam
• trazodone
• triazolam
• trimipramine
• zaleplon
• zolpidem

http://dx.doi.org.ezp.waldenulibrary.org/10.1176/appi.books.9780890425596

http://bjpo.rcpsych.org/content/2/6/e16

This content was created by the National Sleep Foundation

Is pain keeping you awake? Find out why pain affects sleep and what you can do to sleep better.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

The impacts of pain-related sleep loss on millions of Americans are far-reaching. The problem is a notable one given the number of Americans who suffer from pain. The 2015 Sleep in AmericaTM Poll finds that 21 percent of Americans experience chronic pain and 36 percent have had acute pain in the past week. Those combine to a majority of the nation’s adult population, 57 percent, leaving 43 percent who report being pain free.

How does pain affect sleep?
Pain joins two related concerns – stress and poor health – as key correlates of shorter sleep durations and worse sleep quality. But there are paths to resolving the problem: The sleep gap narrows sharply among those who make sleep a priority.

Pain is a key factor in the gap between the amount of sleep Americans say they need and the amount they’re getting – an average 42 minute sleep debt for those with chronic pain and 14 minutes for those who’ve suffered from acute pain in the past week.

By contrast, there’s no overall sleep debt for those without pain – but significant numbers even in this group do have sleep problems. About one in three of those with no pain don’t always or often get a good night’s sleep or the sleep they need to feel their best, or have had trouble falling or staying asleep in the past week. Those problems rise even higher among individuals who do have chronic or acute pain.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Beyond sleep debt, self-reported sleep quality and stress levels underscore the effects of pain on sleep.

Sixty-five percent of those with no pain reported good or very good sleep quality, while only 45 percent of those with acute pain and 37 percent of those with chronic pain did the same. Additionally, 23 percent of those with chronic pain reported higher stress levels, compared with 7 percent of those without pain.

Those with acute or chronic pain are more likely to have sleep problems impact their daily lives. Among people who’ve had sleep difficulties in the past week, more than half of those with chronic pain say those difficulties interfered with their work. That drops to 23 percent of those without pain. People with pain are also far more apt than others to report that lack of sleep interferes with their mood, activities, relationships and enjoyment of life overall.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

People with pain also feel less control over their sleep, worry more about lack of sleep affecting their health and exhibit greater sleep sensitivity. They’re more likely than others to say environmental factors make it more difficult for them to get a good night’s sleep. These factors include noise, light, temperature and their mattresses alike, suggesting that taking greater care of the bedroom environment may be particularly helpful to pain sufferers.

While both chronic and acute pain relate to lost sleep, the survey indicates that chronic pain is an especially powerful problem. Indeed, nearly one in four people with chronic pain, 23 percent, say they’ve been diagnosed with a sleep disorder by a doctor, compared with just 6 percent of all others.

Sleep is a key indicator of overall health
Americans who say they have very good or excellent health and quality of life report sleeping 18 to 23 minutes longer on average in the past week than those who rate their health and quality of life as just good, fair or poor. Indeed, reported sleep duration and quality decline linearly with each health rating, showing that perceptions of one’s sleep and health are deeply related.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

“Sleep quality and duration should be considered a vital sign, as they are strong indicators of overall health and quality of life,” said Kristen Knutson, PhD, National Sleep Foundation Sleep in America™ Poll Scholar. “Extremely long or short sleep durations are associated with more specific conditions, but for many people who are close to getting the recommended seven to nine hours of sleep, getting just 15 to 30 minutes more sleep a night could make difference in how they feel.”

Making sleep a priority is linked to better sleep, even among those with pain
Americans who said they were very or extremely motivated to get enough sleep reported sleeping 36 more minutes per night across the week compared with others (7.3 vs. 6.7 hours). Even among those with pain, a higher motivation to get sleep was associated with longer sleep durations and better sleep quality. That’s a striking metric, indicating as many as 4.2 hours more sleep per week in motivated individuals.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Pain and sleep: a preventable cycle
When pain is first experienced, most people do not experience sleeplessness. However, when pain becomes a problem, it can be a vicious cycle. If someone experiences poor sleep due to pain one night, he or she is likely to experience more problems the next night and so on. It gets worse and worse every night.

Also we know that pain triggers poor sleep. For instance, someone experiencing lower back pain may experience several intense microarousals (a change in the sleep state to a lighter stage of sleep) per each hour of sleep, which lead to awakenings. However, microarousals are innocuous for a person not experiencing chronic pain. Pain is a serious intrusion to sleep. Pain is frequently associated with insomnia and these coexisting problems can be difficult to treat. One problem can exacerbate the other.

What can people do at home?
Practicing good sleep hygiene is key to achieving a good night’s sleep. Some tips for people with chronic pain are:Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Stop or limit caffeine consumption.
Limit alcohol intake, particularly in the evening.
Use of pain killers and/or sleeping pills are effective, but should be used under the supervision of a physician.
Practice relaxation techniques, such as deep abdominal breathing.
When is it time to see a doctor?
It is time to find a sleep professional when pain causes sleep problems and you are unable to fall asleep again. There are a variety of treatments available to ease the sleep problems of chronic pain sufferers, including medication and physical therapy.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

The new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) mandates that coexisting medical and mental conditions be independently specified when treating patients.2 This mandate acknowledges the bidirectional and interactive effects of coexisting medical and mental disorders.2 This conceptualization reflects a paradigm shift away from causal attributions, which is widely recognized in sleep medicine.

A sleep disorder, like chronic pain, may eventually become its own disease or centralized.3 The DSM-5 sleep-wake disorders are intended for use by general mental health and medical providers. There are 10 DSM-5 sleep-wake disorders: insomnia, hypersomnolence, narcolepsy, breathing-related, circadian rhythm, non–rapid eye movement (NREM) sleep arousal, nightmare, rapid eye movement (REM) sleep behavior, restless legs syndrome (RLS), and substance/medication-induced sleep disorders.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Sleep-wake disorders and chronic pain often co-exist but require recognition so both are treated.

Prevalence of Sleep Problems
Insomnia is the most prevalent of all the sleep-wake disorders. It involves a subjective complaint of problems initiating and/or maintaining sleep or nonrestorative sleep. There are 4 main types of sleep problems that can occur in insomnia: delays in sleep onset, difficulty maintaining sleep, early awakening, and/or mixed. Insomnia is associated with a range of problems, including clinically significant impairment or distress in social, occupational, and other important areas of functioning.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

About one-third of adults report having insomnia symptoms (approximately 10% to 20% report significant symptoms in primary care), with 6% to 10% having symptoms that meet the criteria for insomnia disorder.4 Approximately 5% to 10% of patients consulting with sleep clinics are diagnosed with hypersomnolence. It is estimated that about 1% of the US general population has episodes of sleep inertia.5 Narcolepsy-cataplexy affects less than 0.05% of the general population.6 Obstructive sleep apnea is very common, affecting 2% to 15% of middle-aged adults and more than 20% of older adults.7 Central sleep apnea comorbid with opioid use occurs in approximately 30% of individuals taking chronic opioids for nonmalignant pain and those receiving methadone maintenance therapy.8 From 5% to 10% of the night worker population is estimated to have a sleep disorder.9 The lifetime prevalence of sleepwalking in adults is 29%, with a past-year prevalence of sleepwalking of 4%.5 The prevalence of sleep terror episodes is approximately 2% in adults.10 The prevalence of monthly nightmares and frequent nightmares is 6%11 and 1% to 2%, respectively, among adults.12 The prevalence of REM sleep behavior disorder is approximately 0.5% in the general population.13 The prevalence rates of RLS range from 2% to 7%.14 Substance-induced sleep disorders can occur with alcohol, caffeine, cannabis, opioids, sedative, hypnotics, anxiolytics, amphetamines, stimulants, tobacco, and medications.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Studies suggest that 50% to 70% of chronic pain patients suffer from a sleep disturbance,15-19 and at least 89% of patients seeking treatment for chronic pain report at least 1 complaint related to a disturbed sleep and wake cycle.20 Sleep disturbances differ according to the pain syndrome with which they are associated, and the data about these disturbances are irregular.21 People with chronic pain reported more chronic insomnia (48.6%) than did those without chronic pain (17.2%).22 At least 60% of rheumatoid arthritis patients report sleep problems, according to some data.23 Previous studies also have found increased arousals and sleep fragmentation in fibromyalgia patients compared to controls.24

Similarly, pain is influenced by the presence and type of sleep disturbance. Patients with chronic insomnia report more chronic pain (50.4%) than people without insomnia (18.2%),22 and several investigators have reported the presence of comorbid primary sleep disorders other than insomnia in patients with chronic pain conditions.25 Sleep apnea, RLS, and periodic limb movements in sleep are the most commonly cited ailments associated with pain.26 For example, sleep apnea is diagnosed in 17% of headache patients, which exceeds population rates.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

It is quite clear that pain impairs sleep. However, there is evidence of a bidirectional relationship between pain and sleep.28 Increased daytime pain is linked with poor subsequent nighttime sleep, and poor sleep is, in turn, associated with augmented next-day pain.28

How Are Sleep and Pain Related?
A typical sleep pattern can be divided into 5 stages based on brain-wave patterns from electroencephalography (EEG) ( Table 1). The first 4 stages are called non-rapid eye movement (non-REM) sleep and the last stage is called REM sleep. The sleep cycle lasts 100 minutes and recurs 4 to 6 times per night depending on the length of time one sleeps. REM periods are 10 minutes long early in the night but increase to up to 50 minutes by the end of sleep. In contrast, delta sleep is longest early in the night and shorter at the end of the night.29

In patients who suffer from chronic pain, a self-perpetuating cycle can be set in motion in which joint, myofascial, or musculoskeletal disease leads to fatigue, which leads to decreased aerobic exercise and physical deconditioning. As patients spend more time in bed, their basic circadian cycle is disrupted. As a result, the basic physiologic rhythm of sleep is lost. The lack of movement and sleep leads to more pain, further sleep disruption, dysphoria, and more fatigue (Figure 1). Sleep deprivation produces hyperalgesic changes according to most studies.30 Obtaining either less than 6 or more than 9 hours of sleep has been associated with greater next-day pain in the general population.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

The analgesic effect of recovery during sleep apparently is greater than the analgesia induced by compounds in healthy volunteers.32 Circadian rhythms also might be altered by the timing of various factors, including naps, bedtime, exercise, and exposure to light. Exercise and phototherapy have been used to help patients achieve better sleep.33 For example, strenuous exercise during the day may promote better sleep, as long as it’s at least 3 hours before bedtime.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

How Is the Diagnosis Different in the DSM-5?
The diagnosis of primary insomnia in the DSM-IV has been renamed insomnia disorder to avoid the differentiation of primary and secondary insomnia. DSM-5 also distinguishes narcolepsy from other forms of hypersomnolence. The breathing-related sleep disorders were divided into 3 distinct disorders: obstructive sleep apnea hypopnea, central sleep apnea, and sleep-related hypoventilation. The subtypes of circadian rhythm sleep-wake disorders also were expanded to include advanced sleep phase syndrome, irregular sleep-wake type, and non-24-hour sleep-wake type. Rapid eye movement sleep behavior disorder and RLS, which fell under dyssomnia not otherwise specified in DSM-IV, now are independent disorders.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

How Do You Assess for a Sleep Disorder?
When assessing a patient for a sleep disorder, providers should begin with a careful medical history, which includes questions about the time required to fall asleep, number and length of awakenings, length of time spent in bed after awakening in the morning, and length of time after arising before feeling sleepy again, as well as questions about bed type, sleep position, and sleep description. Also, providers may want to elicit information about caffeine and alcohol intake and physical activity patterns. Some key questions should be related to specific sleep disorders, such as obstructive sleep apnea, narcolepsy, and RLS. A sleep diary, in which patients record their sleep habits on a daily basis, can be helpful.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

There are several scales and questionnaires providers can use to assist in the retrospective assessment of sleep, including the sleep-interference visual analogue scale (from “strongly agree” to “strongly disagree”), the Pittsburgh Sleep Quality Index, the Pittsburgh Sleep Questionnaire, the Pre-Sleep Arousal Scale, the Epworth Sleepiness Scale, the Insomnia Severity Index, and the Sleep Disorders Questionnaire. A referral to a sleep medicine clinic or other provider specializing in sleep disorders (eg, psychologist) may be recommended for further assessment.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

The diagnosis of sleep disorder is reserved for conditions identified with an objective sleep physiology study or polysomnographic evidence. A polygraph machine records change in bioelectric potentials using electrodes placed on the skin of the scalp and face. An EEG measuring brain waves, an electrooculogram (EOG) measuring eye movements, and an electromyogram (EMG) measuring muscle activity are recorded.34 Another innovative method for objective sleep monitoring—actigraphy—measures the sleeper’s activity during the night and day but is unable to distinguish between true sleep and moments of motionless wakefulness.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

What Does the Treatment of Insomnia Look Like?
Specific sleep disorders have specific treatments that can improve sleep for individuals with chronic pain. For example, continuous positive airway pressure (CPAP), use of a mouth appliance, decreased alcohol intake, and weight loss may be recommended for sleep apnea. A combination of adrenergic-blocking agents, levodopa/carbidopa combinations, and benzodiazepines have been used for RLS.34 However, the overall treatment approach to sleep in patients with chronic pain is based on optimizing pain control, identifying and treating psychiatric comorbidity, carefully investigating sleep patterns, and using sleep-specific pharmacotherapeutic and psychotherapeutic interventions to improve sleep.3

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Medications often show little ongoing benefit for sleep and cause significant side effects.34 Epidemiologic studies show that 2.2% to 15% of US patients with insomnia report sedative-hypnotic use.35 Opioids have complex effects on sleep architecture and are known to increase nocturnal movements and arousals,36 cause daytime somnolence, and have a sedating effect,37 and patients may develop a tolerance to them over time.38 Traditional benzodiazepines should be discontinued if they are being used for sleep rather than anxiety because of their abuse potential and negative effect on sleep.3 If patients are being treated for comorbid depression, it is important to use sleep- friendly antidepressants (eg, trazodone and mirtazapine) rather than selective serotonin reuptake inhibitors.39 Pain experts also have found that newer anticonvulsants (eg, gabapentin) and atypical antipsychotics (eg, quetiapine) may be useful to improve sleep.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

When considering psychotherapeutic interventions to improve sleep, Cognitive Behavior Therapy for Insomnia (CBT-I) is widely regarded as one of the most effective treatments.40 Some of the CBT-I techniques—including sleep restriction, stimulus control, and relaxation—are independent treatments for insomnia that have strong research support.41

Sleep restriction therapy uses a form of systematic sleep limitation in which a sleep window is established and maintained to allow the body to relearn proper sleeping dynamics and increase sleep efficiency. Stimulus control therapy reduces the conditioned arousal individuals may experience when attempting to go to bed. Specifically, a set of instructions (going to bed only when sleepy; getting out of bed when unable to sleep; using the bed/bedroom only for sleep and sex; arising at the same time every morning; and avoiding naps) designed to reassociate the bed/bedroom with sleep and to re-establish a consistent sleep schedule are implemented.

Relaxation-based treatments teach formal exercises focused on reducing somatic tension (progressive muscle relaxation and autogenic training) or intrusive thoughts at bedtime (imagery training and meditation) and have been found to be equivocally effective. A 12-member National Institute of Health panel found general relaxation training helpful in chronic pain and insomnia.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Biofeedback is yet another modality that has modest research support for the treatment of insomnia.41 Biofeedback is a training technique delivered by a trained mental health professional that conveys information about a patient’s bodily functions that are typically considered outside conscious control. When treating insomnia, biofeedback often is used in conjunction with relaxation training or other behavioral approaches. Biofeedback also has been shown to be effective for chronic pain management.43

In the next installment on the Mental Health A to Z Series, the author will discuss neurocognitive disorders and pain.

The internal mechanisms that regulate our almost ceaseless cycles of sleep and wakefulness make up a remarkable system. However, a variety of internal and external factors can dramatically influence the balance of this sleep-wake system.

Changes in the structure and function of the brain during development can have profound, if gradual, effects on sleep patterns. The amount of sleep we obtain generally decreases and becomes more fragmented throughout our lifespan. These and other variations associated with age are covered at length in the essay Changes in Sleep with Age.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Other factors that affect sleep include stress and many medical conditions, especially those that cause chronic pain or other discomfort. External factors, such as what we eat and drink, the medications we take, and the environment in which we sleep can also greatly affect the quantity and quality of our sleep. In general, all of these factors tend to increase the number of awakenings and limit the depth of sleep.

Light’s Effect
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Light exposure can cause our biological clock to advance or delay, which affects our sleep and wake cycle.

Light is one of the most important external factors that can affect sleep. It does so both directly, by making it difficult for people to fall asleep, and indirectly, by influencing the timing of our internal clock and thereby affecting our preferred time to sleep.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Light influences our internal clock through specialized “light sensitive” cells in the retina of our eyes. These cells, which occupy the same space as the rods and cones that make vision possible, tell the brain whether it is daytime or nighttime, and our sleep patterns are set accordingly.

Due to the invention of the electric lightbulb in the late 19th century, we are now exposed to much more light at night than we had been exposed to throughout our evolution. This relatively new pattern of light exposure is almost certain to have affected our patterns of sleep. Exposure to light in the late evening tends to delay the phase of our internal clock and lead us to prefer later sleep times. Exposure to light in the middle of the night can have more unpredictable effects, but can certainly be enough to cause our internal clock to be reset, and may make it difficult to return to sleep.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Jet Lag and Shift Work
Normally, light serves to set our internal clock to the appropriate time. However, problems can occur when our exposure to light changes due to a shift in work schedule or travel across time zones. Under normal conditions, our internal clock strongly influences our ability to sleep at various times over the course of a 24-hour period, as well as which sleep stages we experience when we do sleep.

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Long-distance travelers experience “jet lag” as their internal clock adjusts to the new day-night cycle.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Individuals who travel across time zones or work the night shift typically have two symptoms. One is insomnia when they are trying to sleep outside of their internal phase, and the other is excessive sleepiness during the time when their internal clock says that they should be asleep. Half of all night shift workers regularly report nodding off and falling asleep when they are at work. This should be seen as an important concern both for individuals and society, given that airline pilots, air traffic controllers, physicians, nurses, police, and other public safety workers are all employed in professions in which peak functioning during a night shift may be critical.

The effects of shift work and jet lag on sleep are covered in much greater detail in Jet Lag and Shift Work and You and Your Biological Clock.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Pain, Anxiety, and Other Medical Conditions
A wide range of medical and psychological conditions can have an impact on the structure and distribution of sleep. These conditions include chronic pain from arthritis and other medical conditions, discomfort caused by gastroesophageal reflux disease, pre-menstrual syndrome, and many others. Like many other sleep disruptions, pain and discomfort tend to limit the depth of sleep and allow only brief episodes of sleep between awakenings.

Individuals of all ages who experience stress, anxiety, and depression tend to find it more difficult to fall asleep, and when they do, sleep tends to be light and includes more REM sleep and less deep sleep. This is likely because our bodies are programmed to respond to stressful and potentially dangerous situations by waking up. Stress, even that caused by daily concerns, can stimulate this arousal response and make restful sleep more difficult to achieve.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Medications and Other Substances
Many common chemicals affect both quantity and quality of sleep. These include caffeine, alcohol, nicotine, and antihistamines, as well as prescription medications including beta blockers, alpha blockers, and antidepressants.

Dr. Epstein
Smoking and Sleep (0:56)
Dr. Lawrence Epstein describes how nicotine in cigarettes can prevent or disrupt sleep.

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The pressure to sleep builds with every hour that you are awake. During daylight hours, your internal clock generally counteracts this sleep drive by producing an alerting signal that keeps you awake. The longer you are awake, the stronger the sleep drive becomes. Eventually the alerting signal decreases and the drive to sleep wins out. When it does, you fall asleep.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

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Caffeinated products decrease a person’s quality of sleep.

A chemical called adenosine, which builds up in the brain during wakefulness, may be at least partly responsible for sleep drive. As adenosine levels increase, scientists think that the chemical begins to inhibit the brain cells that promote alertness. This gives rise to the sleepiness we experience when we have been awake for many hours. Interestingly, caffeine, the world’s most widely used stimulant, works by temporarily blocking the adenosine receptors in these specific parts of the brain. Because these nerve cells cannot sense adenosine in the presence of caffeine, they maintain their activity and we stay alert.

Dr. Epstein
Caffeine and Sleep (0:43)
Dr. Lawrence Epstein describes how caffeine works to promote alertness, but can also inhibit restful sleep.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

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If sleep does occur following the intake of caffeine, the stimulant’s effects may persist for some time and can influence the patterns of sleep. For instance, caffeine generally decreases the quantity of slow-wave sleep and REM sleep and tends to increase the number of awakenings. The duration of its effect depends on the amount of caffeine ingested, the amount of time before sleep that the person ingests the caffeine, the individual’s tolerance level, the degree of ongoing sleep debt, and the phase of the individual’s internal clock.

Alcohol is commonly used as a sleep aid. However, although alcohol can help a person fall asleep more quickly, the quality of that individual’s sleep under the influence of alcohol will be compromised. Ingesting more than one or two drinks shortly before bedtime has been shown to cause increased awakenings—and in some cases insomnia—due to the arousal effect the alcohol has as it is metabolized later in the night. Alcohol also tends to worsen the symptoms of sleep apnea, which will further disrupt sleep in people with this breathing disorder.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

Dr. Amira
Alcohol and Sleep (0:26)
Dr. Stephen Amira describes how alcohol consumption can lead to disrupted sleep.

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Dozens of prescription drugs that are used to help control common disease symptoms may have varying effects on sleep. Beta blockers, which are used to treat high blood pressure, congestive heart failure, glaucoma, and migraines, often cause decreases in the amount of REM and slow-wave sleep, and are also associated with increased daytime sleepiness. Alpha blockers, which are also used to treat high blood pressure and prostate conditions, are linked to decreased REM and increased daytime sleepiness. Finally, antidepressants, which can decrease the duration of periods of REM sleep, have unknown long-term effects on sleep as a whole. Some antidepressants, from the class of drugs known as SSRIs, have been found to promote insomnia in some individuals.Therapy for Clients With Pain and Sleep/Wake Disorders Essay

The Sleep Environment
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Light and temperature effect the quality and restfulness of your sleep.

The bedroom environment can have a significant influence on sleep quality and quantity. Several variables combine to make up the sleep environment, including light, noise, and temperature. By being attuned to factors in your sleep environment that put you at ease, and eliminating those that may cause stress or distraction, you can set yourself up for the best possible sleep.

We’ve already noted that too much light at night can shift our internal clock and makes restful sleep difficult to achieve. To minimize this effect, nightlights in hallways and bathrooms can be used. As for noise, although background sounds may relax some people, the volume level must be low. Otherwise, increased frequency of awakenings may prevent transitions to the deeper stages of sleep. Research shows that the ideal temperature range for sleeping varies widely among individuals, so much so that there is no prescribed best room temperature to produce optimal sleep patterns. People simply sleep best at the temperature that feels most comfortable. That said, extreme temperatures in sleeping environments tend to disrupt sleep. REM sleep is commonly more sensitive to temperature-related disruption. For example, in very cold temperatures, we may be deprived entirely of REM sleep. Lastly, it is worth mentioning that the preferences of a spouse or bedmate may have a significant effect on sleep, especially when a partner’s sleep and wake times vary, or if he or she snores or suffers from sleep-disordered breathing.Therapy for Clients With Pain and Sleep/Wake Disorders Essay