From counting sheep to sleep — workshop, sleep research provide surprising sleep solutions

Think about the worst sleep you’ve ever had. How did it make you feel the next day? Were you able to do all of the things you wanted or planned to do? Exercising, seeing friends, studying, reading? And going through your day, did you feel joyful and happy about your life?

That, says health and wellness educator Katie Kutryk, is how she opens her workshops on the importance of sleep. Participants quickly get the point.

Later this week, she presents two workshops for students — one at Bannatyne campus, the other at Fort Garry — that explore the effects of sleep and why it should be a priority — and she will offer some helpful tips for a good night’s rest.

Kutryk, who is also a registered nurse and alumna who graduated from the Faculty of Nursing, has always been interested in the aspects of nursing that include public health and health education. The sleep workshops are part of a program of monthly workshops she presents in her acting position with the health and wellness unit of Student Affairs.

“There’s no magic wand,” she says. But there are things that students — and others — can do to take control of their health, including their sleep.

According to Kutryk, simply making sleep a priority can go a long way towards solving an ongoing sleep problem.

 

“We are all part of a busy culture. Juggling so many things, our sleep is often the first thing to go,” she says. “We readily sacrifice sleep for seemingly more important tasks, tumbling us into a trap of sleepless nights and exhausted mornings.”

Though some sleeplessness is normal, since sleep is affected by circumstances, simply finding ways of making sleep a priority can go a long way towards solving an ongoing sleep problem. “I try to help students to understand the consequences of sleep deprivation, to become self-motivated to change some of their habits around sleep,” says Kutryk.

One thing she suggests is to think about sleep in terms of scheduling.

Just as you schedule other important things in your life, she says, you should schedule sleep. “Think about what you can change in your schedule to ensure you are getting enough sleep,” she adds.

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The sheepness of sleeplessness. // Illustrations by Kaitlin O’Toole

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But what if sleepless nights become a chronic issue?

Norah Vincent has been researching sleep disturbance for 15 years. Research by the associate professor of clinical health psychology in the Faculty of Medicine, has shown that sleep hygiene — those changeable behaviours around sleep often touted as the solution to sleep difficulties — isn’t enough.

Norah Vincent, associate professor, clinical health psychology, Faculty of Medicine.

In fact, her research on the effectiveness of treatments has shown sleep hygiene to be the least effective in tackling sleep disorders. Vincent is also director of the behavioural sleep medicine clinic, located at the Health Sciences Centre.

Vincent: “Stay awake as long as you possibly can.”

 

So, what to do? The single most important thing you can do if you’re experiencing frequent insomnia is not to go bed too early, she says.

“Stay awake as long as you possibly can.”

Sounds counter-intuitive, but sleep restriction, Vincent explains, basically increases the drive for sleep, which is disrupted when a person hasn’t slept well for a long period of time.

“We ask people to delay their bedtime until the time they would normally be falling asleep, and often times that’s several hours later.

“To do that for for a number of days, maybe up to a week, and then when they start sleeping better again, to slowly back up their bedtime and make it a little bit earlier,” she says.

The other thing that’s very important is working with your mind when you wake up during the night.

 

The other thing that’s very important is working with your mind when you wake up during the night, says Vincent.

“We have busy minds, planning or rehearsing the day and so forth. Learning some ways to manage that so that those thoughts don’t just pop into your mind the moment you wake up, leaving you feeling jazzed up and ready to go.”

This longer-term, cognitive behavioural therapy (CBT) insomnia treatment is unlike more common sleep hygiene tips dispensed to those without a medical sleep disorder such as insomnia.

“We know now that frequent insomnia does not go away and it needs to be addressed specifically, ”

 

And, according to Vincent, insomnia is often overlooked as a potential diagnosis — sleeplessness is frequently seen as a symptom of other potential conditions, rather than recognized as an underlying medical disorder in itself.

“What we know now is that frequent insomnia does not go away and it needs to be addressed specifically, ” she says.

About eight to nine per cent of the population in Canada meet the criteria for insomnia disorder — regular problems with falling asleep and staying asleep, and resulting difficulty during the daytime, from concentration to irritability.

There are significant day-to-day and longer-term impacts for those who suffer from insomnia.

For instance, says Vincent, “We know from data that sleep-deprived people are about 60 per cent more reactive to upsetting situations.

“Every time a person has moderate or severe insomnia, they lose about nine hours of productive work time each week. So there really is a major occupational impact as well, aside from your health,” she says.

“There’s compelling data showing now that having insomnia leads to twice the risk of developing a stroke, becoming overweight, developing an anxiety or a mood problem.”

There’s also new research that shows that if you treat insomnia in addition to depression, you double the remission rate, she says.

“You increase the chance of the person becoming depression-free if you treat the insomnia along with the depression.”

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 The internet as sleep aid?

Over the past decade, the researcher has also been looking into distance-delivery of treatment to Manitobans who aren’t sleeping well. Computerized and telehealth treatments developed by Vincent and her team have offered some surprising insight into what works.

In 2010, the six-week, CBT internet-based program developed by Vincent and her team for residents in rural areas won a Leading Edge Practice Award with Accreditation Canada. The published study also made news in some very well-read popular forums; stories appeared in The New York Times and Time magazine’s family and life section.

What’s been most surprising about their recent studies, she notes, is that working on a sleep treatment alone seems have the same effects as in-person treatment.

Recently, Vincent conducted a study that compared results between those who worked in-person with a psychologist  and those who worked on a computerized program in their homes. The outcomes were very similar.

Vincent: “We get a lot of positive feelings from autonomously solving problems — [insomnia] is one of those problems where that’s possible.”

 

It seems that the benefits of independent treatment add to the solution. Vincent: “Working the problem on your own, you’re likely to feel more empowered and in control of your sleep.”

“We get a lot of positive feelings from autonomously solving problems — and this is one of those problems where that’s possible.”

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Diana MacMillan sees the effects of impoverished sleep firsthand.

The associate professor from the Faculty of Nursing, who has recently been cross-appointed as associate professor of clinical practice at the Health Sciences Centre, researches sleep from a population health perspective. Her work is in the area of intervention research.

Much of McMillan’s research has focused on nurses and other health care professionals — since they are a group whose work can mean long periods without sleep, or shift work that affects sleep patterns.

Diana McMillan, associate professor, Faculty of Nursing.

For McMillan, gathering scientific data on these factors for overall health or the effectiveness of interventions such as night shift naps can lead to changes in policy, the work environment or personal sleep health practices.

McMillan: “A nurse needs to be alert, effective and making good decisions at 3 a.m., despite a body rhythm that expects them to be sleeping.”

As she says, “Many health care professionals, and nurses in particular, provide care to patients on a twenty-four hour basis. Providing patient care is emotionally, cognitively and physically demanding.

“A nurse needs to be alert, effective and making good decisions at 3 a.m., despite a body rhythm that expects them to be sleeping. This has implications for both nurse and the patient health and safety.”

Working with colleagues Marie Edwards, another associate professor in Nursing, and Wendy Fallis, former director of research (now retired) at Victoria General Hospital, McMillan is conducting a study to understand the experiences of intensive care nurses and nurse managers. A second study with Edwards focuses on student nurses.

In both studies, she says, “we are gaining insight into the nurses or student nurses perspectives in terms of the resources, barriers and demands of work and school on sleep health — and on the risks and experiences related to the consequences of fatigue.”

Their long-term goal is to partner with key stakeholders to develop better strategies for health care organizations and for educational institutions, in order to support sleep health and fatigue management for current and future nurses.

“Interventions that address these challenges, in the context of the real world of patient care, are critical. They keep our nurses and future nurses healthy and safe and they promote the health and safety of the patients in their care,” she says.

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There are two prongs to intervention research.

Generally speaking, “intervention research uses scientific methods to produce knowledge with potential to change health outcomes,” explains McMillan.

A new initiative at the Canadian Institutes of Health Research (CIHR) is about population health intervention research, she adds.

“That initiative targets change in policy and program interventions that can impact health at the population level.”

According to the CIHR website, population health interventions are policies, programs and resource distribution approaches that make an impact on a number of people by changing underlying conditions of risk and reducing health inequities.

Examples of such interventions include introduction of organizational changes in workplace design, housing policies to reduce homelessness, immunization programs and new taxes on products such as tobacco.

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Her enthusiasm for sleep health research and promotion is a motivating factor for McMillan.

She adds, “For me, sleep health research is an exciting and gratifying lever for positive health change.”

“I get to work with great teams, targeting interventions to improve the health of patients, students, health professionals, and my university community.

“Now how fun is that?!”

Exercise and good sleep are closely related and combine to support health, says McMillan.

 

Like Vincent and Kutryk, she notes that longer-term negative health effects of impoverished sleep are another reason “we should all try to make healthy sleep practice a priority.”

Its effects are significant for learning, relationships, health and safety, McMillan says. She’s also researching the link between sleep and exercise, and their combined influence on overall health.

In one of her studies on sleep health, she is part of the team of researchers led by Danielle Bouchard, a researcher from the Faculty of Kinesiology and Recreation Management. Together, they explore the possibilities for treadmill use at work to reduce sedentary behaviour.

McMillan is particularly interested in how treadmill use might enhance sleep health.

“It is great to be part of this health promotion team, as exercise and good sleep are closely related and combine to support health,” she says.

Mariianne Mays Wiebe