The Future of Sleep Studies

GE Healthcare and Johns Hopkins Hospital Sleep Disorders Center Earn Achievement Award

The Future of Sleep Studies | Johns Hopkins Medicine

Jun 08, 2010

With services provided by Sleep Services of America, Johns Hopkins Sleep Disorders Center honored for raising awareness, improving hospital sleep environment.

SAN ANTONIO, TX, JUNE 8, 2010 — GE Healthcare (NYSE:GE) shares the National Sleep Achievement Award with Johns Hopkins Hospital Sleep Disorders Center during a presentation at SLEEP 2010, the 24th Annual Meeting of the Associated Professional Sleep Societies in San Antonio, Texas. Sleep Services of America, Inc.

(SSA), co-owned by GE and Johns Hopkins, provides key technical services to the hospital's Sleep Disorders Center.

The award, presented by ADVANCE for Respiratory Care and Sleep Medicine, a magazine covering the fields of pulmonology, respiratory care and sleep, recognizes the Center for a range of innovative programs, including initiatives to promote sleep awareness among hospitalized patients and to improve the hospital's sleep environment.

SSA is a nationwide provider of sleep-facility management, staffing, equipment and accreditation services. Owned 75 percent by GE Healthcare and 25 percent by Johns Hopkins, SSA has been serving Johns Hopkins for over a decade.

“We're delighted that we have received such a prestigious award with Johns Hopkins Hospital Sleep Disorders Center,” said SSA President John H. Mathias II. “Our relationship with Johns Hopkins has kept SSA at the forefront of sleep medicine.”

“We're working hard to help patients understand the importance of sleep to their physiological and mental health. Without the strong partnership of SSA and Johns Hopkins, we would not be as successful in meeting our overall goals,” said Mathias.

Medical Director Nancy Collop, M.D., heads the Johns Hopkins Hospital Sleep Disorders Center's 12-member team of pulmonologists, neurologists, psychologists and anesthesiologists. Collop also serves on SSA's medical advisory board and is the incoming President Elect of the American Academy of Sleep Medicine.

In 2005, the company SSA was the recipient of the first Frost and Sullivan Sleep Service Provider Industry Innovation and Advancement Award for its developmental and educational programs, and its efforts to standardize certification among various accreditation bodies.

ABOUT GE HEALTHCARE

GE Healthcare provides transformational medical technologies and services that are shaping a new age of patient care.

Our broad expertise in medical imaging and information technologies, medical diagnostics, patient monitoring systems, drug discovery, biopharmaceutical manufacturing technologies, performance improvement and performance solutions services help our customers to deliver better care to more people around the world at a lower cost. In addition, we partner with healthcare leaders, striving to leverage the global policy change necessary to implement a successful shift to sustainable healthcare systems.

Our “healthymagination” vision for the future invites the world to join us on our journey as we continuously develop innovations focused on reducing costs, increasing access and improving quality and efficiency around the world.

Headquartered in the United Kingdom, GE Healthcare is a $16 billion unit of General Electric Company (NYSE: GE). Worldwide, GE Healthcare employs more than 46,000 people committed to serving healthcare professionals and their patients in more than 100 countries.

For more information about GE Healthcare, visit our website at www.gehealthcare.com.

For our latest news, please visit http://newsroom.gehealthcare.com. 

Autumn Latimore

Source: https://www.genewsroom.com/press-releases/ge-healthcare-and-johns-hopkins-hospital-sleep-disorders-center-earn-achievement

The Future of Sleep Studies

The Future of Sleep Studies | Johns Hopkins Medicine

Have you ever wondered how researchers perform sleep studies? Is the information they collect accurate? Most sleep studies are performed in a lab, and participants sleep overnight hooked up to monitors that allow researchers to track their sleep. That could soon be changing, and researchers may soon be getting more accurate data on sleep.

Charlene Gamaldo, M.D. is the medical director of the Johns Hopkins Center for Sleep at Howard County General Hospital. According to Gamaldo, new technology is changing the future of sleep studies, and opening up a whole new world of possibilities.

“The brick-and-mortar model of conducting sleep studies in a medical care center is really going to be fading into the sunset or will be minimal at best,” explains Gamaldo.

New models of testing, using new technology, will allow researchers to collect data on sleep while allowing participants to sleep in the comfort of their own homes.

Lab studies are still useful in some instances, because having all participants sleep in a controlled environment, away from distractions or other interferences, will provide more consistent data. Some studies also require more technically detailed monitoring that can’t be performed by the at home devices.

The Future of At-Home Sleep Testing Technology

At-home sleep testing technology is revolutionizing the way we study sleep, and these portable devices can monitor sleep patterns, restlessness, night-time breathing, and even heart rate.

Not only that, but some monitoring devices can measure brain wave activity during sleep, showing researchers how quickly you fall asleep, how deep your sleep is, how much time per night you spend in REM sleep, and if the quality of your sleep is good or bad.

These sleep testing devices can also look for signs of restless legs syndrome, track movements during the night, and even diagnose sleep apnea or other sleep disorders.

Testing sleep in a lab has provided invaluable insights to doctors and researchers, but no one denies that sleeping in a lab will have an effect or your normal sleep patterns.

Testing sleep in the comfort of your own home will give researchers a better understanding of sleep, and allow doctors to monitor your sleep to easily look for signs of sleep disorders, or discover why you’re not waking up feeling well rested.

Can Cellphone Apps Monitor Sleep?

Your friends have started talking about smartphone apps that monitor the quality of your sleep, track how many hours you sleep per night, and how many times you’ve woken up. These apps are often relatively accurate, and are getting better at detecting problems in sleep, such as snoring or restless nights.

“We hope to eventually correlate the information with actual features of sleep disorders,” says Gamaldo, “which could indicate the presence of conditions sleep apnea.

” Just a few years ago, this was a sleep disorder that could only be tested and diagnosed in a sleep lab, but Gamaldo is hopeful that even cellphone apps could soon diagnose disorders.

If you’re using a sleep app, be sure it’s from a reputable source, and is providing you with accurate data.

Before scientists will be able to use apps to track sleep, they’ll need to do a lot of testing to validate the results, and see if the apps are doing what they claim to do.

Until then, researchers and doctors will continue to use at-home sleep testing technology to get an accurate picture of your sleep.

Future Fields of Sleep Study

As researchers are able to make use of at-home testing, there’s an increased push to learn more about sleep disorders sleep apnea, restless leg syndrome, and insomnia. More data is available then ever before, and researchers continue to learn about the effects of not getting enough sleep.

Sound Sleep Medical

Chronic lack of sleep is widespread, and millions of Americans are sleeping less than 7 hours per night. Rather than sleeping soundly, many people spend hours every evening staring at computer, TV, and phone screens that emit blue light which interferes with the natural sleep cycle. Life stressors and busy schedules also contribute to sleep deprivation and fatigue.

If you’ve been struggling to get a good night’s sleep, visit us today at Sound Sleep Medical to find out more about sleep disorders, and how to build healthy sleep habits that will help you sleep soundly every night.

Source: https://www.soundsleepmedical.com/blog/the-future-of-sleep-studies/

Johns Hopkins physicians propose quality measures to improve medical billing

The Future of Sleep Studies | Johns Hopkins Medicine
Johns Hopkins Medicine physicians have proposed five quality measures for medical billing that they hope will be the first step toward national billing quality standards in the future. Credit: Johns Hopkins Medicine

If you're concerned about rising health care costs and overwhelming medical bills, you're not alone.

According to statistics reported in 2019:

  • Approximately 30% of an average health care bill is paid for pocket by the patient (Association of Credit and Collection Professionals International).
  • About 67% of Americans are either very worried or somewhat worried about unexpected medical bills, compared to only 41% who are concerned about not being able to pay their rent or mortgage (Kaiser Family Foundation).
  • Of 1,000 patients surveyed, 64% said they delayed or neglected seeking medical care in the previous year because of concerns about high medical bills (20/20 Research).
  • More than 25% of 5 million consumers surveyed had delinquent debt on their credit reports, with 58% of that liability coming from medical bills (U.S. Consumer Financial Protection Bureau).

In an effort to help address this growing national problem, two physicians at Johns Hopkins Medicine, Simon Mathews, M.D., and Martin Makary, M.D., M.P.H., have proposed five quality measures for medical billing. The metrics are detailed in an article in the Feb. 4, 2020, issue of The Journal of the American Medical Association (JAMA).

“In recent years, patient care and outcomes have been significantly improved by applying quality science to medicine, benchmarking the performance of both health care providers and facilities, yet there are no standardized metrics for billing quality,” says Makary, professor of surgery at the Johns Hopkins University School of Medicine and an authority on health care quality.

“We hope that our proposal will be the first step toward achieving the goal of national billing quality standards,” says Mathews, assistant professor of medicine and head of clinical innovation at Johns Hopkins Medicine's Armstrong Institute for Patient Safety and Quality.

The Billing Quality 5-Star Rating System that Matthews and Makary propose includes the following measures (shown as published in the JAMA article):

  • Itemized bills—Are patients routinely provided an itemized bill with items explained in plain English?
  • Price transparency—Are patients provided real prices for common “shoppable” services when they ask?
  • Service quality—Can patients speak with a billing representative promptly about a concern they have about their bill and be informed of a transparent review process?
  • Suing patients—For patients who have not entered into a written agreement specifying a price for a medical service, does the institution sue patients to garnish their wages, place a lien on their home or involuntarily withdraw money from a patient's income tax return?
  • Surprise bills ­- Are out-of-network patients paying pocket expected to pay more than the region-specific, reference-based price [a price outside of that set by traditional insurance carriers]? and
  • Are patients billed for complications stemming from National Quality Forum (NQF) serious reportable events?

The NQF is a non-profit organization that promotes patient protections and health care quality through measurement and public reporting.

In 2009, it established the first list of serious reportable events (also known as “never events”), a set of largely preventable and harmful clinical practices and behaviors —such as operating on the wrong part of the body or having to remove a foreign object left behind during surgery—that should never occur.

“Given the wide variation in both pricing and collection practices by hospitals, measures of billing practices are needed,” the authors stated in the JAMA article. “Billing quality is a type of medical quality.”

The authors also write that “… metrics of billing quality could be used to create public accountability for U.S. hospitals” and that “… incorporating measures of billing quality into reports of overall hospital quality could provide patients with a more complete assessment of a given medical center or practice.”

“Financial toxicity—the difficulties a patient has related to the cost of medical care—is a medical complication,” Makary says. “Taking care of a patient means taking care of the whole person.”

Source: https://medicalxpress.com/news/2020-02-johns-hopkins-physicians-quality-medical.html

Logan Schneider

The Future of Sleep Studies | Johns Hopkins Medicine

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From a research perspective, my long-term career plan is to refine the understanding of normal and dysfunctional sleep, much the Epilepsy Phenome/Genome Project (EPGP) and Epi4K are doing for the enigmatic epilepsies.

Insufficient sleep has been deemed a public health problem with poorly understood behavioral and physiologic sleep disorders lying at the core of the issue. I am currently using well-defined distinct and objective phenotypes (e.g.

periodic limb movements, hypocretin-deficient narcolepsy) to acquire the analytic skills necessary to expand my knowledge of both signal processing and genetics, with the former enhancing my ability to identify and/or refine sleep phenotypes, and the latter facilitating the pathophysiological understanding of these phenotypes.

As a consequence of a better link between symptoms/phenotypes, physiology, and genetic risks, more personally targeted and effective therapeutics can be developed to address the enriched spectrum of sleep disorders.

  • AAN Annual Meeting Sleep Topic workgroup member, American Academy of Neurology (2017 – Present)
  • AASM Trainee Symposia Series Subcommittee member, American Academy of Sleep Medicine (2017 – Present)
  • Editorial Board member, Practical Neurology (2017 – Present)
  • Educational Products Subcommittee member, American Academy of Sleep Medicine (2016 – Present)
  • Graduate Education Subcommittee member, American Academy of Neurology (2015 – Present)
  • Awards Workgroup member, American Academy of Neurology (2015 – 2017)
  • Commentary on “The Association Between Biomarkers and Neuropsychiatric Symptoms Across the Alzheimer's Disease Spectrum”. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric PsychiatryBeaudreau, S. A., Schneider, L. 2020
  • Frequency and Severity of Autonomic Symptoms in Idiopathic Hypersomnia. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep MedicineMiglis, M. G., Schneider, L., Kim, P., Cheung, J., Trotti, L. M. 2020 STUDY OBJECTIVES: We aimed to quantify the symptoms of autonomic nervous system (ANS) dysfunction in a large online cohort of patients with IH, and to determine how the severity of these symptoms interacts with sleepiness, fatigue, and quality of life.METHODS: One hundred thirty-eight IH patients and 81 age- and sex-matched controls were recruited through the website of the Hypersomnia Foundation, a U.S.-based patient advocacy group. Twenty-four confirmed IH patients were selected by the study investigators as a comparison group. All participants completed a battery of online sleep, autonomic, and quality of life questionnaires including the composite autonomic symptom score-31 (COMPASS-31).RESULTS: Online and confirmed patients reported significantly higher COMPASS-31 scores (43.6 [33.6-52.7] & 32.9 [21.7- 46.8] vs. 17.6 [11.7-27.9], p View details for DOI 10.5664/jcsm.8344View details for PubMedID 32039754
  • Images: Facial cataplexy with demonstration of persistent eye movements. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep MedicineSchneider, L., Ellenbogen, J. 2020; 16 (1): 157–59 None: A patient was transferred for management of “medication-refractory seizures” after failure of levetiracetam and valproate dual therapy. She had a life-long history of two types of events: periods in which she would rapidly and uncontrollably lapse into unconsciousness, and spells in which she would “pass out” but maintain consciousness, the latter happening with increasing frequency in association with laughing, as of late. She also reported hypnogogic/hypnopompic hallucinations, sleep paralysis, and disrupted nocturnal sleep. A clinical diagnosis of narcolepsy was made. The prevailing pathophysiological concept of narcolepsy details “partial intrusions of REM” sleep into wakefulness. Healthy REM sleep includes generalized atonia, but with preservation of eye movements, respiratory function, and sphincter tone. Cataplexy recapitulates this pattern, and is often induced by extreme emotions, laughter in this case. Despite generalized and severe weakness and areflexia during this patient's cataplectic events, she was able to volitionally move her eyes, which is consistent with the physiology of REM sleep. The diagnosis of cataplexy is often missed, due to clinicians being unfamiliar with the findings and the lack of ability to induce sufficient emotional responses to trigger an episode. This example of cataplexy is also quite characteristic of the “cataplectic facies.” The ability to observe the infrequently observed phenomenon of cataplexy serves as a reminder that consciousness is preserved, as are extra-ocular muscle movements.View details for DOI 10.5664/jcsm.8148View details for PubMedID 31957646
  • Study Design Considerations for Sleep Disordered Breathing Devices. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep MedicineMann, E. A., Nandkumar, S., Addy, N., Demko, B. G., Freedman, N. S., Gillespie, M. B., Headapohl, W., Kirsch, D. B., Phillips, B. A., Rosen, I. M., Schneider, L. D., Stepnowsky, C. J., Yaremchuk, K. L., Eydelman, M. B. 2020 None: In recent years, sleep disordered breathing (SDB) has been recognized as a prevalent but under-diagnosed condition in adults and has prompted the need for new and better diagnostic and therapeutic options. To facilitate the development and availability of innovative, safe and effective SDB medical device technologies for patients in the United States, the Food and Drug Administration (FDA) collaborated with six SDB-related professional societies and a consumer advocacy organization to convene a public workshop focused on clinical investigations of SDB devices. Sleep medicine experts discussed appropriate definitions of terms used in the diagnosis and treatment of SDB, the use of home sleep testing versus polysomnography, clinical trial design issues in studying SDB devices, and current and future trends in digital health technologies for diagnosis and monitoring SDB. The panel's breadth of clinical expertise and experience across medical specialties provided useful and important insights regarding clinical trial designs for SDB devices.View details for DOI 10.5664/jcsm.8226View details for PubMedID 31992406
  • Active Learning in Psychiatry Education: Current Practices and Future Perspectives. Frontiers in psychiatrySandrone, S., Berthaud, J. V., Carlson, C., Cios, J., Dixit, N., Farheen, A., Kraker, J., Owens, J. W., Patino, G., Sarva, H., Weber, D., Schneider, L. D. 2020; 11: 211 Over the past few decades, medical education has seen increased interest in the use of active learning formats to engage learners and promote knowledge application over knowledge acquisition. The field of psychiatry, in particular, has pioneered a host of novel active learning paradigms. These have contributed to our understanding of the role of andragogy along the continuum of medical education, from undergraduate to continuing medical education. In an effort to frame the successes and failures of various attempts at integrating active learning into healthcare curricula, a group of educators from the A. B. Baker Section on Neurological Education from the American Academy of Neurology reviewed the state of the field in its partner field of medical neuroscience. Herein we provide a narrative review of the literature, outlining the basis for implementing active learning, the novel formats that have been used, and the lessons learned from qualitative and quantitative analysis of the research that has been done to date. While preparation time seems to present the greatest obstacle to acceptance from learners and educators, there is generally positive reception to the new educational formats. Additionally, most assessments of trainee performance have suggested non-inferiority (if not superiority). However, occasional mixed findings point to a need for better assessments of the type of learning that these new formats engender: knowledge application rather than acquisition. Moreover, this field is relatively nascent and, in order to ascertain how best to integrate active learning into psychiatry education, a framework for quantitative outcome assessments is needed going forward.View details for DOI 10.3389/fpsyt.2020.00211View details for PubMedID 32390876
  • Author response: Incorporating sleep medicine content into medical school through neuroscience core curricula. NeurologyStrowd, R. E., Schneider, L., Gamaldo, C. E., Salas, R. M. 2019; 93 (3): 133
  • Education Research: Flipped classroom in neurology: Principles, practices, and perspectives. NeurologySandrone, S., Berthaud, J. V., Carlson, C., Cios, J., Dixit, N., Farheen, A., Kraker, J., Owens, J. W., Patino, G., Sarva, H., Weber, D., Schneider, L. D. 2019; 93 (1): e106–e111 How to most effectively deliver a large amount of information in an engaging environment that encourages critical thinking is a question that has long plagued educators. With ever-increasing demands on both resident and faculty time, from shrinking duty hours to increased patient complexity, combined with the exponential growth of medical knowledge and unequal access to the spectrum of neurologic subspecialties around the country, this question has become especially pertinent to neurology residency training. A team of educators from the American Academy of Neurology's A.B. Baker Section on Neurological Education sought to review the current evidence regarding the implementation of the flipped classroom format. This educational model has only recently been applied to health care education along the training continuum, and a small collection of articles has, so far, used disparate methods of curricular implementation and assessment. While the feedback from learners is generally positive, a number of obstacles to implementation exist, most notably learner time commitments. These are presented with discussion of potential solutions along with suggestions for future studies.View details for DOI 10.1212/WNL.0000000000007730View details for PubMedID 31262995
  • Autonomic Symptom Burden in Idiopathic Hypersomnia Kim, P., Cheung, J., Schneider, L., Trotti, L., Miglis, M. LIPPINCOTT WILLIAMS & WILKINS. 2019 View details for Web of Science ID 000475965907001
  • Neurological and neuroscience education: mitigating neurophobia to mentor health care providers Sandrone, S., Berthaud, J., Arista, M., Cios, J., Ghosh, P., Gottlieb-Smith, R., Kushlaf, H., Mantri, S., Masangkay, N., Menkes, D., Nevel, K., Sarva, H., Schneider, L. LIPPINCOTT WILLIAMS & WILKINS. 2019 View details for Web of Science ID 000475965901092
  • ULTRADIAN CYCLE OF SLOW-WAVE ACTIVITY IN OLDER ADULTS. Kawai, M., Schneider, L., O'Hara, R. OXFORD UNIV PRESS INC. 2019 View details for Web of Science ID 000471071001051
  • Daylight saving time transitions are not associated with increased seizure incidence. Epilepsia

Source: https://profiles.stanford.edu/logan-schneider

Can Better Sleep Help You Manage Anxiety?

The Future of Sleep Studies | Johns Hopkins Medicine

I can’t tell you how often people in therapy tell me they struggle with a good night’s sleep. They might have trouble falling or staying asleep. I get it. I’ve had times in my life when the thought of trying to sleep gave me incredible anxiety because I was sure it wouldn’t be easy.

Struggling with sleep once in a while isn’t that big of a deal. However, if you don’t sleep well night after night, the sleeplessness creates undue stress on your brain and body.

Why Is Sleep So Important?

An article on the Johns Hopkins Medicine website explains that, “If we sleep too little, we become unable to process what we’ve learned during the day and we have more trouble remembering it in the future.” So sleep affects how we store memory. If you’re having difficulty remembering things because you’re not sleeping enough, then it can be hard to stay on task, focus, and feel on top of your life.

A lack of quality sleep can affect your physical health and your immune system as well. Sleep deprivation may make you more prone to getting sick or staying sick longer.

Poor sleep quality can also negatively impact mental health. A good night’s sleep can help promote your natural resilience. That’s the quality that helps your mind and body bounce back from bad experiences. According to the Anxiety and Depression Association of America, if you rarely get enough sleep, you could develop an anxiety condition.

A recent study looked at sleep and anxiety. It compared people who don’t get the recommended eight hours of sleep per night with those who slept eight hours or more per night.

The study found people who slept less were more ly to focus on and linger over negative thoughts — much people who struggle with anxiety and depression.

Constant negative thinking can leave you feeling unhappy, stressed, and anxious.

One of the first things I ask people in therapy is, “How much sleep do you get each night?” That’s because I know that getting sleep patterns back on track can make a HUGE difference in managing anxiety.

When your body doesn’t have the opportunity to relax during a good night’s sleep, you start the day already stressed. In contrast, after a good night’s sleep you get to start from a good place every day.

Sleep gives your brain and body the rest they need to work properly.

9 Steps To Help You Sleep Better

  1. Go to bed at the same time each night. When you do, you’re training your body to recognize that it’s time to get ready for sleep.
  1. Turn off electronics at least a half hour before bed. Studies show that electronic devices, even TV, stimulate your brain.

    Turning off all your devices before you get into bed gives you a chance to relax so you can fall asleep more easily.

  1. Create a simple bedtime routine. Your routine could include brushing your teeth, washing your face, turning down the covers or meditating. The key is to be consistent. Give your body signals that sleep is coming soon.

  1. Sleep in a cool, dark room. Coolness and darkness help you fall sleep and stay asleep.
  1. If you can’t sleep after 15 minutes, get up. Getting up might feel the opposite of what you’re trying to do. That’s OK. Lying in bed and trying to force yourself to sleep can make you feel more anxious. Then it’s impossible to fall asleep.

    Get bed, make yourself a cup of herbal tea or hot milk, read, meditate, or listen to soothing music. Don’t automatically look at your phone or the TV. When you feel sleepy again, go back to bed and try again.

  1. Only use your bed for sleeping. Don’t watch TV or work in your bedroom.

    You want your brain to connect the bedroom with sleep, so it knows that when you’re in that room, it’s time to sleep.

  1. Reduce caffeine intake. Limit how much caffeine you drink or eat each day. Be aware that some food and drinks have caffeine and you might not know it.

    If possible, don’t drink caffeinated beverages or eat food with caffeine after 12 o’clock noon.

  1. Try not to nap, even if you had a poor night’s sleep. Napping for more than 30 minutes messes up your natural sleep cycles. A half-hour nap can recharge and refresh you without confusing your body.
  1. Be consistent.

    It’s important to follow the same routines each night so your body and mind get trained to start preparing for sleep.

It can take time and practice to retrain your brain and body, especially if you haven’t tried this before. Be patient and compassionate when sleep doesn’t come.

If you’ve tried these strategies and you’re still struggling with sleep every night, you may want to talk to your primary care physician to see if you have any underlying health conditions. A trained therapist can also help with anxiety or sleep issues.

References:

  1. People who sleep less than 8 hours a night more ly to suffer from depression, anxiety. (2018, January 4). ScienceDaily. Retrieved from www.sciencedaily.com/releases/2018/01/180104152947.htm
  2. The science of sleep: Understanding what happens when you sleep. (n.d.) Johns Hopkins Medicine. Retrieved from https://www.hopkinsmedicine.org/health/healthy-sleep/sleep-science/the-science-of-sleep-understanding-what-happens-when-you-sleep
  3. Sleep and mental health: Sleep deprivation can affect your mental health. (2018, June 19). Harvard Medical School. Retrieved from https://www.health.harvard.edu/newsletter_article/sleep-and-mental-health
  4. Sleep hygiene. (n.d.) American Sleep Association. Retrieved from https://www.sleepassociation.org/about-sleep/sleep-hygiene-tips
  5. Understanding the facts: Sleep disorders. (n.d.) Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/related-illnesses/sleep-disorders

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