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Reply Hollie Although there are still many things we do not understand about sleep, it is well known that there are numerous health concerns that can result from inadequate sleep (Hackley & Kriebs, 2017). Both short-term and long-term consequences can result from sleep disturbances. Short-term consequences of inadequate sleep include: increased stress response, headaches, abdominal pain, mood disorders, fatigue, and decreased cognitive performance (Medic, Wille, & Hemels, 2017). Women with sleep issues during perimenopause and menopause are likely to suffer sleep disturbances for an extended period of time due to hot flashes, night sweats, and other factors (Hackley & Kriebs, 2017). These extended episodes of poor sleep may increase the risk of developing long-term consequences. One long term consequence of inadequate sleep is cardiovascular disease (Medic et al., 2017). Long-term sleep issues are associated with hypertension, higher cholesterol levels, increased atherosclerosis risk, and increased risk of myocardial infarction (Medic et al., 2017). Metabolic issues are also associated with long-term sleep disturbances (Medic et al., 2017). Sleep loss is known to affect energy metabolism, which can ultimately impair insulin sensitivity and increase food intake (Medic et al., 2017). These factors are known to contribute to type 2 diabetes and obesity (Medic et al., 2017). A third health concern of long-term sleep disturbance is the development of different types of cancers (Medic et al., 2017). Melatonin, an important hormone involved in the circadian rhythm and in sleep, has numerous important properties including DNA repair, inhibition of tumor growth, and scavenging free radicals (Medic et al., 2017). During clinic visits, it is always important to take the time to revisit healthy bedtime habits. It is always my goal to avoid medication unless absolutely necessary. Sometimes by revisiting healthy routines or discussing nonpharmacological interventions, patients can see great improvement in their sleep. Some basic sleep hygiene interventions include: having a consistent bed time; choosing relaxing activities before bed; avoiding alcohol, coffee, tea, or other stimulants 4 to 6 hours before bed; avoiding smoking before bed; avoiding heavy meals or spicy foods before bed; increasing daytime physical activity; and creating a comfortable sleeping environment (Santos et al., 2018). Patient should be encouraged to read or journal before bed instead of using electronic devices (Santos et al., 2018). Cognitive behavioral therapy has also been proven effective for treating insomnia (Santos et al., 2018). References Hackley, B. K., & Kriebs, J. M. (2017). Primary care of women(2nd ed.). Burlington, MA: Jones & Bartlett Learning.Medic, G., Wille, M., & Hemels, M. E. (2017). Short- and long-term health consequences of sleep disruption. Nature and science of sleep, 9, 151161. doi:10.2147/NSS.S134864 Santos, M., Conceição, A., Ferretti-Rebustini, R., Ciol, M. A., Heithkemper, M. M., & Cruz, D. (2018). Non-pharmacological interventions for sleep and quality of life: A randomized pilot study. Revista Latino-Americana de Enfermagem, 26, e3079. doi:10.1590/1518-8345.2598.3079 Reply Hollie Women experiencing perimenopause and menopause often report sleep disturbances. Identify three health concerns related to inadequate sleep and clinically relevant interventions to address these concerns. Perimenopause As a 54-year-old woman currently in perimenopause, I can attest to sleep disturbances. For about a month this past year, I had hot flashes and insomnia. It miraculously all went away, Im hoping for good. Getting a full nights rest is so wonderful when you have experienced the opposite. As Ive learned from my preceptor, you have to have 1 full year with absolutely no bleeding before considered in full menopause; a chapter that Im sure is in my future. Inadequate sleep Depression and Anxiety Baker, Zambotti, Colrain, and Bei, (2018) discuss the relationship between sleep problems with menopausal women and depression. In general, depression increases in menopausal women but the tendency is more with women who are sleep deprived (Baker, Zambotti, Colrain, & Bei, 2018). Once study showed that women who have difficulty getting to sleep have more problems with anxiety and those who have their sleep interrupted have problems with depression (Baker, Zambotti, Colrain, & Bei, 2018). The authors discuss the fact that the circadian rhythm, interrupted during sleep deprivation, plays a role in depression in anxiety (Baker, Zambotti, Colrain, & Bei, 2018).To treat insomnia and depressive symptoms during menopause, there are a few options. Hormone replacement therapy (HRT), serotonin reuptake inhibitors, and behavioral therapy have been investigated (Baker, Zambotti, Colrain, & Bei, 2018). Supplements such as soy isoflavones have assisted in reducing menopausal symptoms including sleep deprivation in some women (Baker, Zambotti, Colrain, & Bei, 2018). Cardiovascular challengesSleep problems interrupt the efficient automaticity of the cardiovascular system and cardiovascular recovery (Baker, Zambotti, Colrain, & Bei, 2018). Insomnia, specifically the shortened amount of sleep has been associated with coronary heart disease, heart failure, hypertension, and acute coronary syndrome (Javaheri & Redline, 2017). Cardiovascular problems are more prevalent when insomnia is chronic; lasting more than three months (Javaheri & Redline, 2017).Behavioral therapy has been known to not only assist with insomnia but with corresponding cardiovascular disease as well (Baker, Zambotti, Colrain, & Bei, 2018). Physiologic changes in Inflammation and Immune FunctionAukley (2018) discusses the relationship between sleep deprivation and immune function. In studies involving animal models there was shown to be a link between impaired immune function and a loss of sleep (Aukley, 2018). Asif, Iqbal, and Nazir (2017) inform us that wakefulness, rapid eye movement and non-rapid eye movement regulate the immune response. Inflammatory mediators increase in response to sleep loss (Asif, Iqbal, & Nazir, 2017).In addition to regulation of sleep, melatonin, a pineal hormone plays a role in immune system regulation (Jehan et al., 2017). Melatonin has been known to assist with sleep deprivation and related immune challenges (Jehan et al., 2017) .References Asif, N., Iqbal, R., & Nazir, C. F. (2017). Human immune system during sleep. American journal of clinical and experimental immunology, 6(6), 9296.Aukley, D. (2018). Poor sleep in the hospital: Contributing factors and interventions. Retrieved from https://www.uptodate.com/contents/poor-sleep-in-the-hospital-contributing-factors-and-interventions?search=inadequate sleep&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2Baker, F. C., de Zambotti, M., Colrain, I. M., & Bei, B. (2018). Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nature and science of sleep, 10, 7395. doi:10.2147/NSS.S125807Javaheri, S., & Redline, S. (2017). Insomnia and Risk of Cardiovascular Disease. Chest, 152(2), 435444. doi:10.1016/j.chest.2017.01.026Jehan, S., Jean-Louis, G., Zizi, F., Auguste, E., Pandi-Perumal, S. R., Gupta, R., Brzezinski, A. (2017). Sleep, Melatonin, and the Menopausal Transition: What Are the Links?. Sleep science (Sao Paulo, Brazil), 10(1), 1118. doi:10.5935/1984-0063.20170003