Supporting Healthy Sleep Hygiene – Why Clinicians Should Avoid Using Benzodiazepines

1. Juliette Montauk, RN, BSN Graduate Psychiatric Mental HealthNurse Practitioner MSN Student Supporting Healthy Sleep Hygiene – Why Clinicians Should Avoid Using Benzodiazepines An Integrative Approach to Sleep Disorders in Rowan County

2. Sleep…..What does it mean for our health “For sleep is that golden chain that ties health and our bodies together.” Thomas Dekker (2003) Digital Image (n.d) Retrieved on April 13, 2018 from http://www.tucambioesahora.com/2016/05/asi-me-libere-del-insomnio.html

3. Chronic Problem – Sleep Disorder • What is a sleep disorder • Difficulty initiating or maintain sleep. • 15% in the United States have a sleep Disorder • Health Outcomes • Impairs functioning • Impaired cognitive abilities • Impaired mood • Increase in chronic illnesses Digital Image (n.d) Retrieved on April 13, 2018 from http://thecollaboratory.wikidot.com/general-psychology2-fa11 (Zhou, Gardiner, Bertisch, 2017; Center for Disease Control (CDC), 2014)

4. Sleep by the Numbers • National sleep stats • Significant insignificant levels of sleep nationwide • 30-40% in Southeast • North Carolina stats • Approximately 32% had, on average, poor sleep • Highest levels in the more rural communities Country View (digital image) (2014). Retrieved from http://file:///C:/Users/jmont/Desktop/UNCCH/primecare/presentation/FS_ShortSleepByState_NC_508tagged.pdf (CDC, 2014) State View (digital image) (2014). Retrieved from http://file:///C:/Users/jmont/Desktop/UNCCH/primecare/presentation/FS_ShortSleepByState_NC_508tagged.pdf

5. Rowan County • Rowan County Stats • Average – 31.7-34.6%

6. Norm of Current Practice Who - Primary Care Providers What - • Serving patients without integrative resources from the community • Pharmacology • Benzodiazepines Digital Image (n.d.) Retrieved on April1 13, 2018 from http://genmaspeaks.blogspot.com/2012/09/the-patient-doctor-relationship-in-era.html

7. Risks of Prescribing Benzodiazepines What are the risks? • Increase in injuries • Risks of addition • Prescribed more frequently to those at risk • Mortality • Respiratory Distress • Overdose • With opioids Digital Image (n.d.) Retrieved on April1 13, 2018 from http://relationshipsreality.com/relationship-risks/ (Markota, Rummans, Bostwick, & Lapid, 2016; National Institute on Drug Abuse, 2018)

8. Current Guidelines • American College of Physician & American Academy of Sleep Medicine • Effective Sleep Hygiene • Sleep Restriction • Cognitive Behavioral Therapy for Insomnia (CBT-I). • Mindfulness (Morgenthaler, Kramer, Alessi, Friedman, Boehlecke, Brown, et al, 2006; Qaseem, Kansagara, Forciea, Cooke, & Denberg, 2016).

9. Integrative Models of Practice • Resources for PCP • Partnerships in Practice – beyond a referral • Integrative Practices • One stop shop (Zhou, Gardiner, Bertisch, 2017)

10. Cultural Awareness • Future work - Understanding high levels of sleep disorders in Rural Communities Digital image (n.d.) Retrieved April 13, 2018 from https://commons.wikimedia.org/wiki/File:Earnest-broyles-farm-tn1.jpg

11. Conclusion • Working towards a solution for sleep disorders • Pharmacology • Temporary solution for insomnia • Causative factor for other potential harms • Integrative Care – • The path for future care delivery

12. This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under M01HP31370, UNC-PrimeCare, $1,920,000.00, 100% financed with governmental sources. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government

13. References Center for Disease Control (CDC). (2014). Sleep and health among adults in North Carolina. Retrieved from http://file:///C:/Users/jmont/Desktop/UNCCH/primecare/presentation/FS_ShortSleepByState_NC_508tagged.pdf Dekker, T. (1969). The gulshorne-booke. Retrieved on April 19, 2018 from http://www.luminarium.org/renascence-editions/dekker2.html Kroll, D. S., Nieva, H. R., Barsky, A. J., & Linder, J. A. (2016). Benzodiazepines are prescribed more frequently to patients already at risk for benzodiazepine-related adverse events in primary care. Journal of General Internal Medicine, 31(9), 1027-1034. 10.1007/s11606-016-3740-0 Markota, M., MD, Rummans, T. A., MD, Bostwick, J. M., MD, & Lapid, M. I., MD. (2016). Benzodiazepine use in older adults: Dangers, management, and alternative therapies. Mayo Clinic Proceedings, 91(11), 1632-1639. doi:10.1016/j.mayocp.2016.07.024 Morgenthaler, T., Kramer, M., Alessi, C., Friedman, L., Boehlecke, B., Brown, T., . . . American Academy of Sleep Medicine. (2006). Practice parameters for the psychological and behavioral treatment of insomnia: An update. American Academy of Sleep Medicine report. 29(11), 1415-1419. 10.1093/sleep/29.11.1415

14. References Morgenthaler, T., Kramer, M., Alessi, C., Friedman, L., Boehlecke, B., Brown, T., . . . American Academy of Sleep Medicine. (2006). Practice parameters for the psychological and behavioral treatment of insomnia: An update. American Academy of Sleep Medicine report. 29(11), 1415-1419. 10.1093/sleep/29.11.1415 National Institute on Drug Abuse. (2018). Benzodiazepines and opioids. Retrieved from https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids Qaseem, A., Kansagara, D., Forciea, M., Cooke, M., and Denberg, T. (2016). Clinical Guidelines CommAmer, & for the Clinical Guidelines Committee of the American College of Physicians. Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125-125. 10.7326/M15-2175 Zhou, E. S., PhD, Gardiner, Paula, MD, MPH, & Bertisch, Suzanne M., MD, MPH. (2017). Integrative medicine for insomnia. Medical Clinics of North America, 101(5), 865-865. doi:10.1016/j.mcna.2017.04.005