Stress Insomnia Output

7/27/2019 Stress Insomnia Output

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UNIVERSITY OF SAN CARLOS

SCHOOL OF HEALTH CARE PROFESSIONS

DEPARTMENT OF NURSING

CASE STUDY:

STRESS INSOMNIA

SUBMITTED BY:

BSN 4B Group 7

Batuigas, Sheila Mae C.

Dumago, Charisse

Mondero, Kristine Rose M.

Mondigo, Armond A.

Mones, Patricia Helen A.

Olayvar, Jennifer P.

Ong, Mary Norriel Y.

Orlanda, Jo Angeli D.

Paulo, Keith Jon P.

Pleños, Tutz Genaida N.

Redido, Francis Gerard H.

Reyes, Paul M.

Romarate, John Raymar M.

Sunpongco, Elyza Kristina V.

SUBMITTED TO:

Mr. Ryan Daniel Dablo, RN



I. Introduction

A Case of C.K.P.C., 16 years old, male student of the University, came to the clinic for

consultation. The client has been experiencing a difficulty in sleeping. He verbalized that thoughts

keep running inside his head. Received Client sitting on a chair, conscious and coherent with the

following vital signs: Blood pressure of 120/80, Respiratory rate of 20 Cycles per minute, Pulse rate

of 86 and a temperature of 36.6C.

Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty

falling asleep, difficulty maintaining sleep, or waking too early in the morning. These result in the

feeling that sleep is not restorative and often are associated with impaired function during the day.

Insomnia is the most common sleep disorder in the United States. About one-third of the adult

population has experienced it at some time and approximately 10% have a persistent problem.

Insomnia can be classified in terms of its duration: transient, short-term, and chronic. Transient and

short-term insomnia are caused by similar factors, but short-term insomnia usually requires a

greater disturbance. Transient insomnia can be described as lasting from one night to a few weeks

and is usually caused by events that alter your normal sleep pattern, such as traveling or sleeping in

unusual environment (e.g., a hotel) .Short-term insomnia lasts about two to three weeks and is

usually attributed to emotional factors such as worry or stress. Chronic insomnia occurs most nightsand lasts a month or more.

Typically, transient or short-term insomnia are caused by similar factors, but the degree of

disturbance is usually greater to experience short-term insomnia. These include: Stress-related

factors significant personal events, such as losing a job, marital problems, stress and generally

worrying. Uncomfortable sleeping environment (too much light or noise, uncomfortable

temperature).Unusual sleeping environment (e.g., a hotel room).Changes in the daily rhythm hm,

such as a change in work shift or jet lag. Acute medical illness or their treatments.

Chronic insomnia may be caused by one of the following: Chronic medical illnesses - Certain

medical illness can interfere with sleep, especially disorders of the heart (congestive heart failure)

and lungs (chronic obstructive pulmonary disease). Other important physical causes include

heartburn, prostatism, menopause, diabetes, arthritis, hyperthyroidism and hypoglycemia.

Sleep disordered breathing - Disorders of sleep that cause one to stop breathing while asleep may

fragment sleep and cause frequent awakenings during the night. This can be seen rarely with

obstructive sleep apnea, but is much more common with central sleep apnea.

Restless leg syndrome (RLS) is an unpleasant tickling, burning, pricking or aching sensations in

the legs that are generally only relieved with movement and tend to occur while relaxing in the

evening hours. A similar and often overlapping disorder is periodic limb movement of sleep, whichare the recurrent movements of the legs during sleep that may cause arousals from sleep.

Psychophysiologic ("learned") insomnia - Many people go to bed worrying about insomnia

because of previous episodes. This creates an anxiety about going to sleep, which usually leads to

greater difficulty sleeping. Biological factors - As we age, sleep becomes lighter and more

fragmented. Older people often struggle with frequent nighttime awakenings and the inability to

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sleep past the very early morning. Also, during our life spans, the internal biological "clock" that

regulates sleep creeps slightly forward, compelling most older people to go to sleep earlier and to

wake earlier. Lifestyle factors - Excessive caffeine consumption, alcohol and drug abuse, smoking,

and poor sleeping habits are often overlooked as cause of chronically disturbed sleep.

Insomnia Statistics: 20-40% of all adults have insomnia in the course of any year, 1 out of 3 peoplehave insomnia at some point in their lives. Over 70 million Americans suffer from disorders of sleep

and wakefulness. Of those, 60% have a chronic disorder.

Children & Sleep Statistics: Over 2 million children suffer from sleep disorders. Estimated that 30 to

40% of children to not sleep enough. Children require an average of 9 to 10 hours of sleep each

night.

Women & Sleep Statistics: Women are twice as likely as men to have difficulty falling and staying

asleep. Pregnancy can worsen sleep patterns. Menopause and hormone changes cause changes in

sleep

Older Adult Statistics: Over half of those over the age of 65 experience disturbed sleep. Those over

65 make up about 13% of the US population, but consume over 30% of prescription drug and 40% of

sleeping pills

General Statistics: Adults require an average of 8 to 8.5 hours of sleep each night. Sleep problems

add an estimated $15.9 billion to national health care costs. 84 classifications of sleep disorders

exist. (http://www.sleepmed.md/page/1896 )

As a student nurse, we could help our patients by being equipped with deep understanding of

the disease and the appropriate interventions suited for them. In this way, we could ensure our

patients that quality care is rendered to them. With us having a wide understanding of the disease,it would then be easy for us to impart teachings on prevention of the occurrence of Stress Insomnia.

Aside from rendering our patients with the appropriate interventions they needed, it is also our

responsibility as a student nurse to provide them information and impart health teachings in order

to improve their condition to the best of our abilities. This study will help the nursing profession by

providing information about the proper management and care for patient with Stress Insomnia. It

will also educate the people, especially those with this disease and vulnerable individuals to seek

medical care to prevent Stress Related Insomnia.

http://www.sleepmed.md/page/1896






II. Objectives

General:

The objective for this case study presentation is to enhance students’ knowledge, skills

and attitude that will aid them in rendering holistic care to future patients suffering in Stress

Insomnia. This study also aims to develop the skills that are applied for the care of patients

with this condition. At the same time, it allows the students to utilize the different attitude

instilled on them, like being respectful, empathetic and patient.

Specific:

After 1-2 hours of case study presentation, the students of University of San Carlos –

School of Health Care Professions – Department of Nursing will be able to:

a.) Define what Stress Insomnia is according to their understanding.

b.) Explain thoroughly the disease process of Stress Insomnia.

c.) Discuss the pathophysiology of Stress Insomnia.

d.) Identify at least 5 clinical manifestations of Stress Insomnia.

e.) Formulate appropriate nursing care plan for patients with Stress Insomnia.

f.) Enumerate at least 2 complications Stress Insomnia.

g.) Discuss the different drugs: indications, mechanism of action, therapeutic effects,adverse effects and contraindications.

h.) Identify and provide the interventions and health teachings needed for the continuum

of care after hospital admission.

i.) Use the NCP as the framework of patient’s care.

j.) Verbalize the importance of rendering appropriate care for patients with Stress

Insomnia.



III. Nursing Assessment

University of San Carlos

College of Nursing

Cebu City

I. PATIENT DEMOGRAPHIC PROFILE:

Name: C.K.P.C. Age / Gender: 16 y.o / Male Status: Single__

Home Address______________________________ ______________________

Religion: Roman Catholic Nationality: Filipino Occupation: None_______

II. HEALTH HISTORY PROFILE:A. Past Medical History

1. Pediatric and Adult Illness

Date Illness Medication Remarks

The patient cannot

recall

The patient cannot

recall

The patient cannotrecall

The patient cannot

recall

Mumps

Cough and colds

Tonsillitis

Measles

The patient cannot

recall any medication

The patient did not take

any medication.

The patient did not takeany medication.

The patient cannot

recall any medication.

Cured

Cured

Cured

Cured

2. Immunizations

Immunizations Doses Dates Remarks

BCG

DPT

OPV

MMR

2

3

3

1

The

patient

cannot

recall

Complete

Complete

Complete

Complete

3. Hospitalization

Date & Year Hospital Institution Diagnosis Duration (No. of Days)

The patient didn’t

hospitalized


hospitalized


hospitalized


hospitalized



4. Injuries and Accidents

The patient didn’t experience any injuries and accidents.

5. Transfusions

The patient has not undergone blood transfusion.

6. Allergies

The patient does not have any allergies.

B. Family History

Family History was not taken due to short interaction with the client. Stress

Insomnia is not heredity, but is greatly affected by the kind of lifestyle a person has.

C. Social and Personal History

1. Occupation

The patient has no job and he is in school.

2. Number of Children

The patient does not have any children.

3. Military experience; foreign travel

The patient has neither experience in military nor any foreign travel.

4. Habits (tobacco, alcohol, non-prescription drugs, others)

The patient drinks alcohol occasionally. He consumes 2-3 glasses of hard drinks every time He

drinks.

5. Diet

The patient eats siomai and pork most of the time. He eats fish sometimes. He seldom eats

vegetables in his meal.

6. Type of Family

The patient has a nuclear type of family.

7. Cultural and Religious BeliefsHe believes in superstitions like “barang.” He is a catholic and he goes to church 2-3 times a

month.

Brief description of average day



6:00 am Wakes up

7:00 am go to school

11:00 am Eats lunch

12:00-2:00 pm Siesta (rests and watches tv)

3:00-6:00 pm class time

6:00-7pm going home

7:00 pm Eats dinner

10:00-12:00 am Watches TV

12:00 are Goes to sleep



A. Review of System (for the past 6 months). Physical Assessment

General Weight loss fatigue anorexia night sweats chills fever

weakness

>Fever related to inflammation of tonsils(tonsillitis)

>Fatigue related to inadequate sleep and rest

Skin Itch rash lesions bruising bleeding color change

>no significant Manifestation.

Eyes Pain discharge itch vision loss excessive tearing diplopia

glasses/contact lens Date of last exam:


Ears Earaches discharges tinnitus hearing loss


Nose

Obstruction discharge Epistaxis

>mucous discharges: greenish in color related to colds.

Throat & mouth Sore throat bleeding gums toothache dentures

>Sore throat related to inflammation of tonsils(Tonsilitis)

Neck & Head Swelling dysphagia hoarseness


Chest Cough sputum: amount & character hemoptysis wheeze pain on

respiration dyspnea

>Cough related to sudden change in weather. Sputum: Colored Green and

sticky

Cardiovascular Precordial pain palpitation dyspnea on exertion paroxysmal nocturnal

dyspnea orthopnea edema heart murmur thrombophlebitisclaudication


Gastrointestinal Heartburn nausea vomiting bloating diarrhea food intolerance

excessive gas or indication constipation change in bowel movement

jaundice melena hemmorhoids hernia


Genitourinary Frequency of urination dysuria hematuria urgency hesistency

incontinence urinary infection stools


Extremities Joint pains varicose veins claudication back pain edema stiffness

deformities




Endocrine Hot flashes hair loss temperature intolerance polydipsia goiter


Neurology Numbness tingling tremor fainting headaches muscle weakness

ataxia unconsciousness paralysis/paresis memory loss dizziness seizure


Psych Anxiety depression sexual problems insomnia nightmares

>Insomnia related to stress, according to the client the difficulty in sleeping,

stress is often initiating it.

Others >Difficulty with memory and Poor concentration as verbalized by client.

I. CURRENT HEALTH PROFILE:

A. Presenting complaints and medical diagnosis to include interventions done prior to hospitalization.

Three weeks prior to check-up, the client has been experiencing a difficulty in sleeping. He

verbalized that thoughts keep running inside his head. Received Client sitting on a chair, conscious and

coherent with the following vital signs: Blood pressure of 120/80, Respiratory rate of 20 Cycles per

minute, Pulse rate of 86 and a temperature of 36.6C.

B. PHYSICAL ASSESMENT (head-to-toe)

General

The patient appears pale. He claims to have difficulty in sleeping for three weeks

already. Patient verbalized weakness and easily gets tired due to lack of sleep. The patient

mentioned that he tries to put his self into sleep until 4am but can only take a sleep about anhour since he still needs to wake up early for his 7:30 am class. Vital signs: temperature- 37 ‘C,

RR- 18 cpm, HR-89 bpm, BP- 120-80mmHg

Head and neck

Patient has a black hair, evenly distributed and tidy. No dandruff found, no swelling and

or lesions on the scalp.

Head has an appropriate size for his body. Eyes are chinky, eyelashes evenly distributed,

eyebags seen on both eyes, pupils dilate when directed with penlight, no swelling and no

tenderness noted. Nose has no discharges, symmetrical in form, no swelling and no lesions

noted. Lips are pale, and moist and no swelling noted. Oral mucosa is moist and pinkish, no

lesions noted. Ears are symmetrical in size and shape and are parallel to each other; no



discharges noted. Face’s skin temperature is normal. No lesions and swelling on the neck. Gag

reflex is okay.

Cardiovascular

Patient can breathe normally. No obstructions noted. No abnormal breath sounds

heard.

Gastrointestinal

Bowel sounds heard in all four quadrants. Patient verbalize that he urinates 3 to 5 times

a day. No pain in urinating, urine color is yellowish and has a funky urine odor. Can defecate one

to two times a day without any complain of pain.

Upper extremities

Skin temperature is normal, no lesions, no scars noted, and no wounds seen. Fair in

color and is evenly distributed, can grab pen, reflexes are normal, fingers are complete. Nail

fingers are clean. Can bend elbows voluntarily, can shrug shoulder with absence of pain. CFT is

more than 3 seconds.

Lower extremities

Patient can walk properly, legs are symmetrical in shape and length, no lesions noted,

no pain in joints claimed.

Neurology

Patient can recognized time, place and the people around. He has a good mind

condition. He verbalizes of difficulty in sleeping for three weeks already and is worried for his

condition.



IV. Anatomy and Physiology

Anatomy

Sleep and wakefulness is a tightly regulated process. Reciprocal connections in the brain produce

consolidated periods of wakefulness and sleep that are entrained by environmental light to occur at

specific times of the 24-hour cycle.

Promotion of wakefulness

Brain areas critical for wakefulness include the tuberomammillary nucleus (TMN) in the posterior

hypothalamus. The TMN contains histamine neurons, which project stimulatory inputs to brainstem

arousal centers such as the locus coeruleus (LC) (norepinephrine), the dorsal raphe nuclei (DRN)

(serotonin), the ventral tegmental area (VTA) (dopamine), and the basal forebrain (acetylcholine). These

brainstem arousal centers (see the image below) project diffusely to cortical areas to promote arousal.

The TMN also inhibits sleep-promoting areas, such as the anterior hypothalamus. Similarly, the

brainstem arousal regions inhibit sleep-promoting regions in the anterior hypothalamus. Adenosine, a

neurotransmitter, accumulates in the brain during prolonged wakefulness and inhibits wake-promoting

regions in the posterior hypothalamus and the basal forebrain. Acetylcholine in the basal forebrain also

projects diffusely to cortical areas and the TMN to promote wakefulness.

The ascending arousal system. Adapted from Saper et al. Hypothalamic Regulation of Sleep and

Circadian Rhythms. Nature 2005;437:1257-1263.

Promotion of sleep

The anterior hypothalamus includes the ventrolateral preoptic nucleus (VLPO), containing gamma-

aminobutyric acid (GABA) and the peptide galanin, which are inhibitory and promote sleep (see theimage below). They project to the TMN and the brainstem arousal regions to inhibit wakefulness. GABA

is the predominant inhibitory neurotransmitter in the central nervous system (CNS).

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Ventrolateral pre-optic nucleus inhibitory projections to main components of the arousal system to

promote sleep.

The homeostatic and circadian processes

Both animal and human studies support a model of 2 processes that regulate sleep and wakefulness:homeostatic and circadian. The homeostatic process is the drive to sleep that is influenced by the

duration of wakefulness. The circadian process transmits stimulatory signals to arousal networks to

promote wakefulness in opposition to the homeostatic drive to sleep. (See the image below.)

Sleep-wake cycle.

Melatonin and the circadian process

The suprachiasmatic nucleus (SCN) is entrained to the external environment by the cycle of light and

darkness. The retinal ganglion cells transmit light signals via the retinohypothalamic tract to stimulate

the SCN. A multisynaptic pathway from the SCN projects to the pineal gland, which produces melatonin.

Melatonin synthesis is inhibited by light and stimulated by darkness. The nocturnal rise in melatonin

increases between 8 and 10 am and peaks between 2 and 4 am, then declines gradually over the

morning.[13] Melatonin acts via 2 specific melatonin receptors: MT1 attenuates the alerting signal and

MT2 phase shifts the SCN clock. The novel sleep-promoting drug ramelteon acts specifically at the MT1

and MT2 receptors to promote sleep.





THE STRESS RESPONSE

Stress can be physical, such as a loud noise, cold temperature, and strenuous activities. It can also be

psychological, such as anxiety, guilt, or joy. Each person’s threshold to stress is different, but is a fact of

everyday life to everyone.

The hypothalamus receives information from almost all parts of the brain including the limbic system,

the emotional brain. The hypothalamus responds to signals of stress by recruiting the sympathetic

division of the autonomic nervous system, also called the flight or fight response.

The body prepares for the flight and fight response by:

1) Shunting blood from the skin and digestive organs to the muscles.

2) Providing more fuel through an increase in glucagon action, in other words, releasing glucose

from stored glycogen. The hypothalamus stimulates a release of ACTH from the anterior

pituitary gland to increase cortisol levels from the adrenal glands.

Cortisol helps to supply cells with amino acids and fatty acids for energy supply while diverting glucose

from muscles for use by the brain. Cortisol and related compounds are sometimes used to reduce

inflammation, but the concentration necessary for inflammation reduction is toxic to the body. These

drugs must be carefully monitored.



V. Pathophysiology



VIII. DISCHARGE PLAN

University of San Carlos

Department of Nursing

Discharge Plan and Instruction

Name: C.K.P.C____Age:_16___Sex: ____Male__Religion:_____Roman catholic_____Diagnosis: _______________Stress Insomnia_________________________________

Surgery Undergone, if Any: _____________ Hospital: __________________________

Rm/Ward-Bed No.: _____________ Physician: _______________________________

A. Objectives (SMART/KSAV)

After Mr. C.K.P.A. will be discharge, he will be able to:

a) Adhere to prescribed medications and treatment.

b) Appreciate the given diet and exercise in promotion of health and wellness.

c) Perform diet recommended and followed restriction given

d) Identify different ways to minimize or prevent complications.

e) Verbalize understanding on disease process and therapeutic regimen.

B.

1. MEDICATIONS

Name of drug DosageFrequency

Route Curative Effects Side Effects

Hydroxyzine diHCl 10g By mouth

short-term

treatment of

nervousness and

tension

Drowsiness, dizziness,

blurred vision, dry

mouth, or headache

2. EXERCISE/ACTIVITY

Type of Activity allowed/to be continued:

Walking exercise at least 15-20 minutes a day.

Deep Breathing Exercises – Perform this when you wake up in the morning, do this for a set 0f 10

cycles while awake to promote lung expansion allowing oxygen to be delivered to the tissues

http://www.webmd.com/brain/tc/dizziness-lightheadedness-and-vertigo-topic-overview

http://www.webmd.com/eye-health/default.htm

http://www.webmd.com/migraines-headaches/default.htm



http://www.webmd.com/eye-health/default.htm

http://www.webmd.com/brain/tc/dizziness-lightheadedness-and-vertigo-topic-overview



Use of equipment (if any): None.

Restrictions: No vigorous exercise prior to sleeping.

3. TREATMENT (prescribed treatment to be continued at home or to a referred health institution.)

Adhere to prescribed diet to promote strength, energy and good nutrition.

Adequate bed rest to prevent fatigue and stress.

Drink water about 8 glasses a day to promote good hydration to the body.

Changing the habits that are reinforcing sleeplessness.

4. HEALTH TEACHINGS (Provide a separate sheet on specified health teachings)

(/) clinic appointment schedules ( ) use of alternative medicines

( ) follow-up laboratory examinations ( ) relapse prevention measures

( ) understanding and knowing what to do with side effects of medications(/) Others: Self-help techniques to cure insomnia

5. a.) OBSERVED SIGNS AND SYMPTOMS THAT NEEDS REPORTING:

SEVERE ANXIETY

DEPRESSION

b.) INTERVENTIONS / HOME REMEDIES that may be done immediately prior to seeking

consultation:

Bed rest Do relaxation activities, like deep breathing exercises.

Instruct the client to sleep/rest in a quiet environment and perform comfort

measures in preparation for sleep such as fixing the bed sheets, back rub and

washing of face

Limiting intake of chocolate and caffeine/alcoholic beverages, especially prior to

bedtime.

Explore other sleep aids such as warm bath and protein intake before bedtime.

6. DIET

Food to eat: Chlorophyll-rich foods, such as leafy green, vegetables, steamed or boiled

Oyster shell can purchased in health food stores and taken as a nutritional supplement

Whole grains: Whole wheat, brown rice, and oats have a calming and soothing effect on the

nervous system and the mind. Carbohydrates also boost serotonin, which promotes better

sleep.

Mushrooms (all types)

Fruit, especially mulberries and lemons, which calm the mind

Seeds: jujube seeds are used to calm the spirit and support the heart. Chia seeds also have a

sedative effect.

Basil

Foods such as bread, bagels, and crackers that are high in complex carbohydrates have a mildsleep-enhancing effect because they increase serotonin, a brain neurotransmitter that promotes

sleep

A glass of warm milk with honey is one of the oldest and best remedies for insomnia. Milk

contains tryptophan which, when converted to seratonin in the body, induces sleep and

prevents waking

Lettuce has a long-standing reputation for promoting healthy sleep. This is due to an opium-

related substance combined with traces of the anticramping agent hyoscyarnin present in



lettuce. Lettuce should be an integral part of your evening diet if you are suffering from sleep

disorders. The meal should also include legumes, peanuts, nutritional yeast, fish or poultry.

These foods contain vitamin B3 (niacin). Niacin is involved in seratonin synthesis and promotes

healthy sleep. Mixed with a little lemon juice for flavor, lettuce juice is an effective sleep-

inducing drink highly preferable to the synthetic chemical agents in sleeping pills

b.) Restrictions:

ALCOHOL, CAFFEINATED DRINKS, coffee, cola and tea can also reinforce sleeplessness,

spicy foods, stimulant drugs, additives, preservatives, Sugar and foods high in sugar and refined

carbohydrates. These raise blood-sugar levels and can cause a burst of energy that disturbs

sleep, Foods that are likely to cause gas, heartburn, or indigestion, such as fatty or spicy foods,

garlic-flavored foods, beans, cucumbers, and peanuts, Monosodium glutamate (MSG), often

found in Chinese food. This causes a stimulant reaction in some people, Foods such as meat that

are high in protein can inhibit sleep by blocking the synthesis of serotonin, making us feel more

alert, Avoid cigarettes and tobacco. While smoking may seem to have a calming effect, nicotine

is actually a neurostimulant and can cause sleep problem

7. SPIRITUAL AND PSYCHOLOGICAL NEEDS

( ) spiritual counseling ( ) confession( X) supportive counseling

( ) grief work ( ) family therapy ( ) join organizations/church activities

( ) anger management ( ) reconciliation of conflicted relationships

A. DISCHARGE DETAILS

a.)

Date and time of discharge:b.) Accompanied by:

c.) Mode of transportation:

d.) General condition upon discharge:

THESE DISCHARGE INSTRUCTIONS WERE EXPLAINED TO THE PATIENT AND / OR RELATIVE

Read and understood: (translated according to patient’s convenience)

: If all measures fail, an interpreter is asked.

PATIENT / RELATIVE

(Signature over printed name)

Validated:

STUDENT NURSE

(Signature over printed name)

CLINICAL INSTRUCTOR

(Signature over printed name

CONTENT:

Self-help techniques to cure insomnia



Another technique for getting insomnia and some other sleep disorders under control is by keeping a

sleep diary.

Practicing this involves keeping a record of the times that you go to bed, wake up as well as when you

experience times of restlessness. You write down your sleeping patterns, but you also keep track of your

daytime habits.

This may help you understand some of the triggers of insomnia.

For example, some issues that often exacerbate insomnia include late-night caffeine, Internet surfing or

watching TV late into the night.

So any natural sleep aids may target these issues through proper sleep hygiene.

Similarly you can use natural sleep remedies such as herbal supplements like valerian or lavender that

may be useful to get a better nights sleep.

Though insomnia is a serious problem that must be treated, you can practice many self-help techniques

to improve the condition.

You can practice a regular routine of yoga, meditation or even deep breathing, all exercises that have

been shown to relieve stress and improve your health.

You can also adopt new habits to help you sleep and prevent nights of sleeplessness. These may include

anything from sticking to a regular sleep schedule to avoiding stressful situations before bedtime or

throughout the day.

All of these techniques, in addition to professional help, can help you combat insomnia effectively.

Treatments for sleep disorders can include a complement of strategies. Some common remedies

include:

Sleep hygiene or behavioral and lifestyle changes

Pharmacological interventions

Non-pharmacologic medications: over-the-counter aids, devices and equipment, natural

remedies, dietary supplements

Alternative therapies: acupuncture, hypnosis, relaxation, massage.

http://www.stress-management-for-peak-performance.com/natural-sleep-aids.html



http://www.stress-management-for-peak-performance.com/natural-sleep-remedies.html





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