Sleep for Healthy AgingPresented by Cheyenne Dixon, OTS

● Gain information regarding the importance of sleep and wake cycles

● Identify what about your current routines is supporting and hindering your sleep and wake cycles

● Be able to incorporate strategies to support sleep and return to sleep

Objectives

● How do you define sleep?

● What do you know about sleep cycles?

Discussion

Sleep Definition● A natural state, absent of wakefulness

and awareness of surroundings that is easily reversible

● Includes changes in brain activity including dreaming as well as changes in body function

● Is made up of REM and non-REM cycles

● Is essential to mental and restorative functions of the body (“Sleep”, n.d.)

Image retrieved from: https://www.lboro.ac.uk/news-events/news/2020/april/coronavirus-lockdown-sleeping-tips/

Sleep Cycles

● Circadian Rhythm

○ The cycle of our day

● REM & Non-REM Cycles

○ The cycles of our sleep

Image retrieved from: https://casper.com/blog/sleep-stages/

Our 24-hour clock that regulates alert and restful states● Sleep & wake times● Dips in energy in afternoon

If you are not caught up on sleep then these dips and rises in energy are felt more intensely

Natural light (or lack thereof) helps to regulate these cycles by triggering the release of ● melatonin for sleep ● cortisol for wakefulness/energy

(“What is the circadian rhythm?,” 2020)

Circadian Rhythm

Image retrieved from: https://truedark.com/circadian-rhythms/

Age Related Circadian Rhythm Changes● Increased preference to waking up early

○ Associated with optimal cognitive performance compared to later afternoon

● Increased difficulty adapting to a changed sleep schedule○ Jet lag or rotating shift work

● Takes longer to fall asleep

(Hood & Amir, 2017)

Image retrieved from: https://psychologybenefits.org/2018/09/26/5-ways-to-improve-sleep-for-healthy-aging/

REM & Non-REM SleepAdults require approximately 7-9 hours of REM & Non-REM sleep

REM (Rapid Eye Movement) - muscles are inhibited, dreams occur, eyes move rapidly under lids

Non-REM Stages (Non- Rapid Eye Movement) - ● Stage 1 - early sleep stage, relaxation occurs but easy to awaken● Stage 2 - ease to awaken becomes more difficult, body relaxes more● Stage 3 - deep sleep for recovery, most difficult to awaken from

(Marieb & Hoehn, 2013, p. 454; NIH, 2019)

Image retrieved from: https://courses.lumenlearning.com/wmopen-psychology/chapter/outcome-sleep-and-dreams/

Age Related Changes to REM & Non-REM Sleep

● Increased difficulty getting to sleep● Increased wakings during the night● Less time spent in stage 3 and REM sleep● Shorter amounts of time asleep

(NIH, 2019; Hood & Amir, 2017; Smallfield & Molitor, 2018)

Image retrieved from: https://www.discovermagazine.com/mind/why-do-people-with-alzheimers-tend-to-sleep-a-lot

Why is Sleep Important?

(Marieb & Hoehn, 2013, p. 455; NIH, n.d.; Epilepsy Foundation, 2018; Sheth & Thomas, 2019)

Optimal Mental Performance● Cognition

○ Memory○ Attention / Focus○ Productivity○ Decision making

● Creativity● Emotion regulation

Optimal Physical Health● Cell repair● Refreshes immune

system● Regulates hormones

○ Blood sugar○ Appetite

Image retrieved from: https://www.headspace.com/sleep/sleep-by-headspace

Discussion

● Why is sleep important to you?

What Can We Do To Support Sleep?

Daily activities to support sleepEngagement in activities throughout the day

Morning● Have a regular sleep schedule ● Exercise (preferably in the morning)

○ 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous aerobic exercise a week

● Get natural light

(WHO, n.d.; Sleepfoundation.org, 2020)

Image retrieved from: https://www.thehealthsite.com/fitness/these-health-benefits-of-morning-walk-will-amaze-you-av1018-610372/

Daily activities to support sleep (cont.)Afternoon● Naps

○ Avoid if possible○ 20 min between 1:00- 3:00 pm

● No nicotine and caffeine 4-6 hours prior to sleep● Avoid excessive fluid intake 4-6 hours prior to

sleep● Elevate legs & feet in the evening● Alcohol● Don’t eat a heavy meal 2-3 prior to sleep

Use bed only for sleep(WHO, n.d.; Sleepfoundation.org, 2020; Leland, Marcione, Schepens Niemiec & Don Fogelberg, 2014; NAFC, 2018)

Image retrieved from: https://www.citymattress.com/blogs/news/the-art-of-the-power-nap-how-to-do-it-and-how-your-mattress-makes-a-difference

Discussion

● What are the things do you do during the day that support your sleep?

● What things do you do that do not support your sleep?

● What things would you like to add to your routine to improve your sleep?

Sleep Preparation

Can Include ...● Self care routine

○ Teeth brushing ○ Washing face○ Using the toilet○ Dressing for sleep

● Preparing the room for sleep○ Turning out lights or closing

curtains○ Adjusting temperature○ Preparing the bed

(Sleepfoundation.org, 2020; Sheth & Thomas, 2019)

The routine one carries out immediately prior to sleep that prepares the body for sleep. Should be at least 30 minutes. It is recommended that there be no screen at least 30 minutes prior to

sleep

Image retrieved from: https://www.retrobunny.org/if-you-want-to-sleep-better-tonight-try-turning-down-your-thermostat/

Sleep Preparation (cont.)● Sounds

○ Reducing sounds○ Music○ White noise○ Other calming sounds

● Relaxation strategies○ Deep breathing○ Yoga○ Mindfulness○ Progressive muscle relaxation○ Journaling ○ Guided imagery

Image retrieved from: https://www.metroparent.com/daily/family-fun/family-activities/journaling-for-families/

(Sleepfoundation.org, 2020; Sheth & Thomas, 2019)

Discussion

What parts of your sleep preparation routine do you feel support your getting to sleep?

What parts of your sleep preparation routine do you feel do not support your getting to sleep?

What would you like to try to add to your sleep preparation routine to support your getting to sleep?

During the night● Use pillows to support proper

positioning ● After 20 minutes of trying to sleep, get

up and do a relaxing activity before returning to bed

● Drink water ● Relaxation Strategies

○ Mindfulness○ Deep breathing○ Guided imagery○ Progressive muscle relaxation

(Desouzart, Matos, Melo & Filgueiras, 2016)

Image retrieved from: https://www.samarth.community/lifestyle/avoid-back-pain-with-healthy-sleeping-positions

Discussion

What are you doing during the night that support your return to sleep?

What things are occuring during the night that inhibit your return to sleep?

What things would you like to try to support your return to sleep?

If lifestyle changes do not workTalk to your Primary Care Physician

Share with them ● About the lifestyle changes you have

made● Results from a sleep diary

Possible questions to ask● How might my current medications be

affecting my sleep?● Could my diet be impacting my sleep?

Questions?

ReferencesDesouzarta, G., Matosa, R., Meloc, F. & Filgueiras, E. (2016). Effects of sleeping position on back pain in physically active seniors: A controlled pilot study.

Work, ;53(2), p. 235-240. doi:10.3233/WOR-152243 Epilepsy Foundation. (2018). Sleep and wellness. Retrieved from https://www.epilepsy.com/living-epilepsy/healthy-living/sleep-and-wellnessNAFC. (2018).How to stop waking up at night to pee. Retrieved from https://www.nafc.org/bhealth-blog/how-to-stop-waking-up-at-night-to-peeNIH. (2019). Brain basics: understanding sleep. Retrieved from

https://www.ninds.nih.gov/disorders/Patient-Caregiver-Education/Understanding-Sleep#2NIH. (n.d.). Sleep deprivation & deficiency. Retrieved from

https://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency#:~:text=Sleep%20plays%20an%20important%20role,pressure%2C%20diabetes%2C%20and%20stroke.

Hood, S. & Amir, S. (2017). The aging clock: circadian rhythms and later life. J Clin Invest. 127(2), p. 437-446. https://doi.org/10.1172/JCI90328.

Leland, N.E., Marcione, N., Schepens Niemiec, S. L. & Don Fogelberg, K.K. (2014). What is occupational therapy’s role in addressing sleep problems among older adults?. OTJR, 34(3), p. 141–149. doi:10.3928/15394492-20140513-01.

Marieb, E.N. & Hoehn, K. (2013). Human anatomy & physiology (9th ed.). Glenview, Il: Pearson. Sheth, M & Thomas, H. (2019). Managing sleep deprivation in older adults: a role for occupational therapy [PDF file]. AOTA. Retrieved from

https://www.aota.org/~/media/Corporate/Files/Publications/CE-Articles/CE-Article-March-2019-Managing-Sleep-Deprivation-Older-Adults.pdfSleep. (n.d.). In Mirriam-Webster.com dictionary. Retrieved from https://www.merriam-webster.com/dictionary/sleepSleepfoundation.org. (2020). Healthy sleep tips. Retrieved from

https://www.sleepfoundation.org/articles/healthy-sleep-tips#:~:text=Whenever%20possible%2C%20give%20yourself%20extra,sleep%20when%20you%20want%20to.

Smallfield, S. & Molior, W. L. (2018). Occupational therapy interventions addressing sleep for community-dwelling older adults: a systematic review. AJOT 72(4). https://doi.org/10.5014/ajot.2018.031211

What is the circadian rhythm? (2020). Retrieved fromhttps://www.sleepfoundation.org/articles/what-circadian-rhythm#:~:text=Your%20circadian%20rhythm%20is%20basically,as%20your%20sleep%2Fwake%20cycle.

WHO. (n.d.). Physical activity and older adults. Retrieved fromhttps://www.who.int/dietphysicalactivity/factsheet_olderadults/en/#:~:text=Older%20adults%20should%20do%20at,%2D%20and%20vigorous%2Dintensity%20activity.