Health Coaching
For Better Sleep
Dody E. Jordahl, CRT
Certified Health Coach
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
About Me
How We View Sleep
• A luxury
 Stressful hours/night shifts/multiple jobs
 Home obligations
 Fast paced lives
• Many things to do other than sleep:
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internet
TV
time with friends/family
email
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).
Sleep and Health
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
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
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-today 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
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
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Obstructive Sleep Apnea
Getting enough sleep
Heart disease
Cancer
Diabetes
Obesity
Lung disease
See the connection?
What Lifestyle Change ?
• Healthy Eating
• More movement
• Less Stress
And of course…
Make Sleep a priority
How Do We Get There?
If we can overcome the Psychological and
Logistical
barriers 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
Willpower
VS.
Intrinsic Motivation
Willpower - control of one's impulses and actions; selfcontrol.
Willpower does not work long term
Danzinger JAMA 06
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?
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
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?
Intrinsic Motivation
Autonomy
Competency
Relatedness
3 Key Needs
Human Motivation
Autonomous vs. Controlled
Autonomy
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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
Promotes Autonomy
Fulfillment
Fulfillment
Contentment
Abundance
Fulfilled but Failure
Fulfilled and Successful
Success
Failure
Rust Out
Burnout
Depressed and Failure
Successful but Depressed
Depression
Controlled
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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
2 Types of Controlled Behavior
1. Compliance (Conformity)
Doing what you are told to do
2. Defiance-(Rebellion)
Doing the opposite of what you are expected to do
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
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
Relatedness
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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!
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
Your Role as a Coach
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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
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
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
Autonomy Supportive
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Praise Can Be Non Controlling or Controlling
What Are Your Own Intentions?
Minimize Controlling Language
Minimize Controlling Style
Coach Competency
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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
Relatedness
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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
Support Network: Micro-Environment of Health
Friends
Family
Educational
Materials
Coach
Patient
Relatedness
Online
Support
Healthy
Peers
Group
Support
33
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
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)
Internalization
Introjection vs. Integration
Two Types
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
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
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
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
Integration
• You Do It Through:
• Rational-Acknowledge-Minimize Pressure
• We Tie Them into The Community
• We Help Them Become Successful
Seems Like A Lot
Your Role as A Coach
Help Your Patients Find Their Intrinsically
Motivation
Intrinsic Motivation
Autonomy
Competency
Relatedness
3 Key Needs
You Help Your Patients to:
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Decide
Desire to Accomplish
Because They Want To
They Understand and See
Themselves Doing It
• The Feel Connected and Desire to
Relate to You!
Teamwork
Building A Healthy New America
References
1. Kohatsu ND, et al. Sleep Duration and Body Mass Index in a Rural Population, Archives of Internal Medicine. 2006 Sep 18; 166(16): 1701.
2. Taveras EM, 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. Kasasbeh E, 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. Colten HR 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,Brief Communication: 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 Coll Cardiol. 2004
Feb 18; 43(4): 678-83.
Questions