Dody E. Jordahl, CRT Certified Health Coach

1. Health Coaching For Better Sleep Dody E. Jordahl, CRTCertified Health Coach

2. Objectives • Describe the interaction between sleep and health, and the lifestyle changes that can improve both. • Discuss the differences between intrinsic motivation and willpower and their impact on coaching for long term success

3. About Me

4. How We View Sleep • A luxury • Stressful hours/night shifts/multiple jobs • Home obligations • Fast paced lives • Many things to do other than sleep: • internet • TV • time with friends/family • email

5. Scary Statistics • Some 70 million people in the United States have a sleep problem. About 40 million adults suffer from a chronic sleep disorder; an additional 20 - 30 million have intermittent sleep-related problems. (National Heart, Lung and Blood Institute) • Effects of sleep loss on work performance may be costing U.S. employers some $18 billion in lost productivity. (NSF 1997 poll on Sleeplessness, Pain, and the Workplace) • America’s adults average 6.9 hours of sleep each night, slightly less than the range of seven to nine hours recommended by many sleep experts. (NSF 2005 Sleep in America poll) • One-quarter of America’s adults, 47 million people, don’t get the minimum amount of sleep they say they need to be alert the next day. (NSF 2002 Sleep in America poll) • One-quarter of America’s adults say their sleep problems have some impact on their daily lives. (NSF 2005 Sleep in America poll) • More than one-half of America’s adults nap at least once a week. (NSF 2005 Sleep in America poll).

6. Sleep and Health

7. Sleep/Health Impact • Obesity—Several studies have linked insufficient sleep and weight gain.1 • Diabetes—Studies have shown that people who reported sleeping fewer than five hours per night had a greatly increased risk of having or developing type 2 diabetes.2,3 • Fortunately, studies have also found that improved sleep can positively influence blood sugar control and reduce the effects of type 2 diabetes.4 • Cardiovascular disease and hypertension—A recent study found that even modestly reduced sleep (six to seven hours per night) was associated with a greatly increased the risk of coronary artery calcification, a predictor of future myocardial infarction (heart attack) and death due to heart disease.5 • There is also growing evidence of a connection between sleep loss caused by obstructive sleep apnea and an increased risk of cardiovascular diseases, including hypertension, stroke, coronary heart disease, and irregular heartbeat.6 Harvard University – http://healthysleep.med.harvard.edu

8. Sleep/Health Impact • Immune function—Interactions between sleep and the immune system have been well documented. Sleep deprivation increases the levels of many inflammatory mediators, and infections in turn affect the amount and patterns of sleep.7 • While scientists are just beginning to understand these interactions, early work suggests that sleep deprivation may decrease the ability to resist infection (see The Common Cold, below). • Common Cold – In a recent study, people who averaged less than seven hours of sleep a night were about three times more likely to develop cold symptoms than study volunteers who got eight or more hours of sleep when exposed to the cold-causing rhinovirus. In addition, those individuals who got better quality sleep were the least likely to come down with a cold. 8 Harvard University – http://healthysleep.med.harvard.edu

9. Sleep/Health Impact • Not surprisingly, these potential adverse health effects can add up to increased health care costs and decreased productivity. More importantly, insufficient sleep can ultimately affect life expectancy and day-to-day well-being. An analysis of data from three separate studies suggests that sleeping five or fewer hours per night may increase mortality risk by as much as 15 percent.9 • Major restorative functions in the body such as tissue repair, muscle growth, and protein synthesis occur almost exclusively during sleep. • Scientists have discovered that insufficient sleep may cause health problems by altering levels of the hormones involved in such processes as metabolism, appetite regulation, and stress response.10,11,12 • Studies such as these may one day lead to a better understanding of how insufficient sleep increases disease risk. Harvard University – http://healthysleep.med.harvard.edu

10. Why Lifestyle Change ? • Many of the major diseases causing death in the United States can be greatly improved by changing our habits and behavior. some of these include • Obstructive Sleep Apnea • Getting enough sleep • Heart disease • Cancer • Diabetes • Obesity • Lung disease • See the connection?

11. What Lifestyle Change ? • Healthy Eating • More movement • Less Stress And of course… Make Sleep a priority

12. How Do We Get There? • If we can overcome the Psychologicaland Logisticalbarriers in our way, we can create a healthy lifestyle and weight in months.What does that mean?Working on the “Stuff” between our ears!!! Danzinger JAMA 06

13. WillpowerVS.Intrinsic Motivation • Willpower - control of one's impulses and actions; self-control. • Willpower does not work long term Danzinger JAMA 06

14. Intrinsic Motivation • It is Why We Do What We Do • It is the Process of Doing An Activity for Its Own Sake • The Reward is Inherent in the Activity Itself • It Creates Feelings of: • Excitement • Accomplishment • Personal Satisfaction What is It?

15. Intrinsic Motivation (IM) • A Child’s Curiosity Mastering the Challenges of Life • Motivation is Something People Do for Themselves • The Desire to Be the Originator of Ones Own Actions • Rather than a Pawn Manipulated by External Forces • Rewards Turn the Act of Playing into Being Controlled from the Outside

16. Intrinsic Motivation (IM) • Are We Better Off Now? (150 hours more work/year) • We Work for Extrinsic Measures House, Job • Money and Modern Life Controls and Creates Alienation • Deadlines, Imposed Goals, Surveillance, Evaluation • Antagonistic to Autonomy FAILURE SUCCESS?

17. Autonomy Intrinsic Motivation Competency Relatedness 3 Key Needs

18. Autonomous vs. Controlled Human Motivation

19. Autonomy • To Act in Accord with One’s Self • Free and Volitional in One’s Actions • People Are Fully Willing to do What They Are Doing • Embrace the Activity with Interest and Desire • Action’s Emanate from Their True Self • They Are Being Authentic • Organizing Your Life Around What Matters Most

20. Rust Out Depressed and Failure Promotes Autonomy Fulfillment Fulfillment Contentment Fulfilled but Failure Abundance Fulfilled and Successful Failure Success Depression Burnout Successful but Depressed

21. Controlled • To Act Because One is Being Pressured • People Act without a Sense of Personal Endorsement • Behavior is Not an Expression of Self • Self Has been Subjugated to the Control • People are Alienated

22. 2 Types of Controlled Behavior • Compliance (Conformity) • Doing what you are told to do • Defiance-(Rebellion) • Doing the opposite of what you are expected to do

23. Competency • Important for Intrinsic Motivation • Person Takes on and in Their View • Meets Optimal Challenges • Works Towards Accomplishment and Mastery • They Are Doing There Best

24. Competency • As People Gain Confidence in Dealing With Themselves and Their World and As They Become More Autonomous in Doing That They Will Perform More Effectively and Display a Greater Sense of Well Being Edward L. Deci Ph.D. Professor of Psychology

25. Relatedness • People Do Not Only Need to Be Effective and Free • They Need to Be Connected • The Need to Love and Be Loved • The Need to Care and Be Cared For • To Be Free to Be Dependent!

26. Your Role as a Coach • Up One: Down One • Parent/Child - Teacher/Student - Health Coach/Patient • In a Position to Give Advise through Guidance • Need to Fully Embrace The 3 Key Factors of Intrinsic • Motivation in Order to Move People Forward

27. Your Role as a Coach • Autonomy Supportive • Help the Patient Become Competent • Connect the Patient to a Support Network • Relatedness : Healthy Peers – Support Group – Friends/Family • Help With Internalization of Our Health System

28. Autonomy Supportive • To Relate to Others as Human Beings not as Objects to Be Manipulated for Our Own Needs • See the World From Their Eyes • It is Not as Easy as Controlling • But it is Our Responsibility

29. Autonomy Supportive • Provide Rationale –Understand Why • Acknowledge – A Person May Not Want to Do It • Minimize Pressure – More Like and Invitation than a Demand • You Will Know Because Their Subsequent Behavior: • They Will Feel Free, Empowered, and Believe it Was Personally Impactful • Not Permissive but They Are Accountable to Themselves Ask if the Have a Setback

30. Autonomy Supportive • Praise Can Be Non Controlling or Controlling • What Are Your Own Intentions? • Minimize Controlling Language • Minimize Controlling Style

31. Coach Competency • Help Your Patients Gain Mastery • Your Patient Takes on and Meets Optimal Challenges • Help them Work Towards Accomplishment • Do Their Best • Praise Only as Non Contingent Not Controlling • You are Their Guide • Increases Their Intrinsic Motivation

32. Relatedness • Connect and Build Your Relationship • Set Avenues of Communication • Help Your Patients Feel Comfortable • Will Come When They Feel Free and Effective • Their Network is an Authentic Community

33. Online Support Educational Materials Friends Family Healthy Peers Group Support 33 Support Network: Micro-Environment of Health Coach Patient Relatedness

34. Internalization • This is the process of our system becoming part of the Individual • It is Moving From It Being Something Being Done to You to Being Inside of You • This is Where True Coach Mastery Occurs The Last Piece

35. Internalization • This is Where People Do it Because: • They Feel Free to Do It (Autonomous) • They Feel Can Do It (Competent) • They Want To Be Connected and Involved With Others (Relatedness)

36. Internalization Introjection vs. Integration Two Types

37. Introjection • This is Doing it Because You Should or Ought • That Some Controlling Force Says You Must • Swallowing a Rule Whole • View it as Something that Pushes You Around • Declares, Demands, Demeans

38. Introjection • Voices in Our Head that Come From the Outside • Create Either Conformity, Half Hearted Adherence or Rebellion • Create stress, confusion, feelings of inadequacy lack of well being • Can not Live up to Them

39. Integration • True Sense of Choice • You Do It Because it Supports Your Autonomy • It is a Secondary Choice which Creates Sustainable Motivation. • You Learn it and Adopt it as a Part of You • Creates Sense of Well Being • Artistic Football Player • Requires You To Relate to Them as Human Beings

40. Integration • Worthy of Your Support • Not Objects to Be Manipulated for Your Own Needs • Must Take Their Perspective • See the World from Their Point of View as We Relate to Them

41. Integration • You Do It Through: • Rational-Acknowledge-Minimize Pressure • We Tie Them into The Community • We Help Them Become Successful

42. Seems Like A Lot

43. Your Role as A Coach Help Your Patients Find Their Intrinsically Motivation

44. Autonomy Intrinsic Motivation Competency Relatedness 3 Key Needs

45. You Help Your Patients to: • Decide • Desire to Accomplish • Because They Want To • They Understand and See Themselves Doing It • The Feel Connected and Desire to Relate to You!

46. Teamwork Building A Healthy New America

47. References 1. KohatsuND, et al. Sleep Duration and Body Mass Index in a Rural Population, Archives of Internal Medicine. 2006 Sep 18; 166(16): 1701. 2. TaverasEM, et al. Short Sleep Duration in Infancy and Risk of Childhood Overweight, Archives of Pediatrics & Adolescent Medicine. 2008 Apr; 162(4): 305. 3. Knutson KL, et al. Role of Sleep Duration and Quality in the Risk and Severity of Type 2 Diabetes Mellitus, Archives of Internal Medicine. 2006 Sep 18; 166(16):1768. 4. Gottlieb DJ, et al. Association of Sleep Time with Diabetes Mellitus and Impaired Glucose Tolerance, Archives of Internal Medicine. 2005 Apr 25; 165(8): 863. 5. Nilsson PM, et al. Incidence of Diabetes in Middle-Aged Men Is Related to Sleep Disturbances, Diabetes Care. 2004; 27(10): 2464. 6. King, CR et al. Short Sleep Duration and Incident Coronary Artery Calcification, JAMA, 2008: 300(24): 2859-2866. 7. KasasbehE, et al. Inflammatory Aspects of Sleep Apnea and Their Cardiovascular Consequences, South Med J. 2006 Jan; 99(1): 58-67. 8. Opp, MR, et al. Neural-Immune Interactions in the Regulation of Sleep, Front Biosci. 2003 May 1;8:d768-79. 9. Cohen S, et al. Sleep Habits and Susceptibility to the Common Cold, Arch of Intern Med. 2009 Jan 12; 169 (1):62-67. 10. ColtenHR and Altevogt BM, eds. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Board on Health Sciences Policy; National Academies Press. 2006. 11. Spiegel K,BriefCommunication: Sleep Curtailment in Healthy Young Men Is Associated with Decreased Leptin Levels, Elevated Ghrelin Levels, and Increased Hunger and Appetite, Annals of Internal Medicine. 2004 Dec 7; 141(11): 846-850. 12. Spiegel K, et al. Impact of Sleep Debt on Metabolic and Endocrine Function, Lancet. 1999 Oct 23: 354(9188): 1435-9. 13. Meier-Ewert HK, et al.Effect of Sleep Loss on C-reactive Protein, an Inflammatory Marker of Cardiovascular Risk, J Am CollCardiol. 2004 Feb 18; 43(4): 678-83.

48. Questions