IV JORNADA DE SUEÑO EN LA PLATA
El 16 de Mayo de 2019 se realizó la IV Jornada de Sueño en La Plata. El evento estuvo a cargo del Servicio de Neurología del Hospital San Martín de dicha ciudad.
En cada evento se buscó difundir información sobre trastornos de sueño para que los profesionales médicos cuenten con herramientas para ayudar a sus pacientes ante esta problemática.
Dormir bien como la actividad física y la alimentación saludable, es fundamental para nuestra calidad de vida.
- Los trastornos de sueño son frecuentes en la población general.
- Entre un 8-18% de la población dice estar insatisfecho con la calidad y/o cantidad de sueño
- La prevalencia de sueño insuficiente es alrededor del 20%, por presiones laborales y estrés psicosocial.
Es por ello que, en esta cuarta edición, se quiso poner el enfoque en la Prevención de los trastornos de sueño.
I. Fisiología del Sueño y Beneficios de un buen dormir
Dra. Verónica Ossola
Sueño
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Función biológica regulada por ritmos circadianos y factores homeostáticos
Ritmos circadianos:
Son cambios fisiológicos cíclicos controlados por el reloj biológico, localizado en el hipotálamo, que tiene estrecha interacción con estímulos ambientales. El ciclo sueño-vigilia depende fundamentalmente del ciclo luz-oscuridad, además de las interacciones sociales, el horario laboral, el esquema de comidas, entre otros.
Un factor de gran importancia en el impulso del sueño, regulado también por ciclo circadiano, es la temperatura corporal central: somnolencia y sueño sobrevienen mientras la temperatura desciende. La temperatura tiende a permanecer elevada en pacientes con insomnio.
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Factores homeostáticos
Determinan la “presión de sueño”, a mayor tiempo despiertos más posibilidades de dormir.
¿Por qué dormimos? Funciones del Sueño
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| ⇒ “Desecha” aquellas que no son necesarias, conserva y “refina” información útil. |
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| ⇒ La información es revisada y consolidada, tiene un papel importante en la codificación de la información. |
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| ⇒ El sueño promueve el desarrollo y crecimiento del cerebro durante la infancia. |
Sueño y maduración a lo largo de los años
Un recién nacido necesita entre 16 y 18 horas de sueño distribuidas en varios episodios diarios. Con la edad, y más aún cercano a la adolescencia, el sueño se organiza en una estructura monofásica con un único episodio nocturno de 9.5 horas promedio. La cantidad de horas disminuye
con los años, un adulto promedio duerme aproximadamente 7 a 8,5 horas por día.
La cantidad de horas que necesitamos dormir están determinadas genéticamente.
¿Qué significa dormir? Concepto de Sueño
Desde un punto de vista de conducta y comportamiento es un estado reversible de desconexión perceptiva y relativa insensibilidad al ambiente típicamente acompañado de decúbito, ojos cerrados y ausencia o leve movilidad.
¿Qué altera nuestro sueño?
- El sueño puede verse alterado por múltiples factores: condiciones médicas (endócrinas, cardíacas, neurológicas, pulmonares o dolores crónicos) y drogas ya sea que produzcan insomnio (broncodilatadores, corticoides) o somnolencia (antihistamínicos).
- Además, es muy sensible al estrés y disturbios emocionales. Ansiedad y depresión son los trastornos más frecuentemente asociados.
- Estilos de vida y factores ambientales: dieta, ejercicio, consumo de cafeína, nicotina, alcohol, siestas, ambiente (ruido, temperatura, luz).
¿De qué trata el estudio Polisomnografía?
Polisomnografía (PSG)
Es el registro simultáneo de múltiples variables fisiológicas durante el sueño.
Etapas de sueño en Polisomnografía: se clasifican teniendo en cuenta la actividad electroencefalográfica, electrooculográfica y electromiográfica de mentón.
- VIGILIA: > 50% de la página con presencia de actividad alfa o bajo voltaje con frecuencias mixtas.
- Sueño No REM N1 (sueño superficial): 50% con actividad de relativo bajo voltaje, frecuencias mixtas y <50% de actividad alfa. Ondas del vértex. Movimientos oculares lentos.
- Sueño No REM N2 (sueño intermedio): husos de sueño y complejos K.
- Sueño No REM N3 (sueño lento profundo): 20% con actividad lenta de alto voltaje y frecuencias de 2 – 3 Hz.
- Sueño REM: actividad de bajo voltaje con frecuencias mixtas, movimientos oculares rápidos y atonía muscular. Ondas serrucho.
Los arousals aumentan con la edad y los despertares pueden ser espontáneos o relacionados con los disturbios respiratorios o movimientos de piernas.
Beneficios de un «buen dormir»
REPARACIÓN FÍSICA: gracias al “bloqueo” de todos los sentidos, descenso de frecuencia cardíaca, frecuencia respiratoria, tensión arterial y liberación de hormona de crecimiento.- MENOS ARRUGAS: Por mayor reparación celular cutánea.
- FIJAR LOS CONOCIMIENTOS: Se “optimiza” la información eliminando aquella innecesaria y archivando la útil.
- MEJOR SALUD CORONARIA.
- BUEN HUMOR: dormir mal altera los procesos neuronales que rigen nuestro comportamiento haciéndonos irascibles y menos sociables.
- MAS CREATIVIDAD
- CONTROL DE PESO: no dormir suficiente se asocia a trastornos hormonales además de hacernos propensos a la ingesta en exceso de alimentos ricos en hidratos de carbono.
- AGILIDAD MENTAL: respuestas más rápidas y menor riesgo de cometer errores.
- IMPULSO DEPORTIVO: Regeneración de tejidos
- FORTALECE EL SISTEMA INMUNE: la falta de sueño genera estrés que interfiere en el funcionamiento de nuestras defensas.
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II. Trastornos de Sueño y sus consecuencias
Dra. Natalia Pereira
En su exposición señaló la importancia de preguntar al paciente en el consultorio cómo duerme por las noches, si descansa bien y cómo se siente durante el día, ya que los trastornos de sueño tienen muchas implicancias en distintas patologías. Presenta y describe las patologías más comunes, el tratamiento de cada una y su posterior seguimiento.
Audio con la exposición completa de la Dra. Natalia Pereira:
III. Mindfulness como herramienta para desarrollar una relación consciente y saludable con el descanso
Lic. en psicología Verónica Cajen
¿Cómo trabaja nuestra mente al irnos a dormir?
Nuestra mente divaga constantemente, y esto hace que cada actividad que realicemos estemos poco conectados, vamos resolviendo en nuestro transitar diario en PILOTO AUTOMÁTICO. Podemos decir que nuestro cuerpo está en el presente, pero nuestra mente a ¿Donde se ha ido? Cuando esto sucede al dormir, revolotea entre pensamientos del pasado y del futuro: estamos ocupados resolviendo problemas, anticipando desastres o repasando infortunios cuando en realidad podríamos estar descansando.
Muchos de nuestros pensamientos son amedrentadores, de los que activan el sistema “lucha o (huida”), se dispara en el cuerpo las mismas reacciones que nos preparan ante una situación de estrés. No es de sorprender que una función de este sistema sea precisamente mantenernos despiertos, el problema es que los “tigres” de dentro pueden estar acechándonos durante toda la noche. Uno de esos tigres puede ser la ANSIEDAD ante la posibilidad de no dormir lo suficiente. Por esto nos suele resultar más fácil dormir los viernes o sábados por la noche que los domingos. Ya que solemos pensar que si no me duermo podre dormir hasta tarde mañana ya que es sábado, pero si esto ocurre el domingo “Si no me duermo pronto estaré zombi mañana, y tengo tanto que hacer…”
Podemos decir que el insomnio se alimenta no solo de nuestra lucha contra los síntomas sino también de otros problemas emocionales. La plena conciencia puede hacer dormir a los “tigres de adentro”.
Tratamiento
El tratamiento se centra en 3 estrategias generales: control de estímulo, higiene del sueño y relajación basado en técnicas de MINDFULNESS.
1- Control de estímulo
Consiste en enseñar a asociar la cama con el sueño, salir de la cama si permanece despierto más de quince minutos, y volver a la cama solo cuando sienta sueño. Se desaconseja comer en la cama, leer, ver la tele o utilizar cualquier tipo de pantalla.
2- Higiene del sueño
Se propone establecer un modelo de sueño regular por la noche. Esto se consigue yendo a la cama a la misma hora, levantándonos a la misma hora y evitando echar pequeñas siestas, aunque hayamos dormido poco por la noche. De esta manera no caeremos en el modelo de recuperar el sueño durante el día para luego sentirnos completamente despabilados por la noche.
En estos dos primeros puntos se realiza psicoeducación con el paciente.
3- Relajación basado en técnicas de MINDFULNESS
Primero debemos definir el Mindfulness como un estado o rasgo que se refiere a la capacidad de estar atento a lo que sucede en el presente con apertura y aceptación. Para Jon Kabat- Zinn (2005) es simplemente “parar y estar presente, eso es todo”. La atención hacia la experiencia presente debe estar asociada a una orientación de aceptación la cual también es intencional. Por lo tanto involucra dos componentes:
- Autoregulación de la atención: mantenerse concentrado en la experiencia inmediata, reconociendo los acontecimientos corporales, sensoriales y mentales del momento presente.
- Orientación abierta hacia la experiencia: el modo de la orientación tiene que ser curiosa, abierta y con aceptación.
Es una capacidad INNATA, pero poco explorada; la cual se puede (re)aprender y entrenar con el uso de las técnicas. Esta capacidad no sustituye otros tratamientos psicológicos ni farmacológicos, sino que puede aportar y beneficiar el trabajo de los mismos ya que no es un tratamiento por sí mismo.
Existen así terapias basadas en Mindfulness que se ligan a la cultura oriental pero aunque tengan su raíz en las técnicas meditativas budistas, se adaptan al contexto occidental y se despojan de connotación religiosas. Entre los principales programas clásicos se encuentran el MSBR (Mindfulness – Based Stress Reduction) y el MBCT (Mindfulness- BasedCognitiveTherapy).
La relajación a partir de realizar meditaciones de mindfulness de plena conciencia como es el anclaje respiratorio y el bodyscan.
El anclaje de respiración diafragmática permite inducir una respiración más lenta, más profunda y mecánicamente impulsada desde el abdomen. Este estilo de respiración se asemeja a la que se produce de forma natural durante la conciliación del sueño.
En la meditación de bodyscan se lleva la atención a las sensaciones físicas del cuerpo realizando un escaneo corporal. Por conciencia corporal, se entiende un proceso dinámico e interactivo por el que se perciben los estados, procesos, y acciones que suceden en el cuerpo tanto a nivel interoceptivo como propioceptivo y que pueden ser observados por uno mismo (Mehling et al., 2005). La investigación indica que mindfulness es una herramienta eficaz para ampliar la conciencia corporal (Naranjo y Schmidt, 2012).
Podemos decir que la toma de conciencia de cómo se encuentra nuestro cuerpo, permite identificar las tensiones, llevando la respiración a cada zona corporal y como efecto de esto la posterior relajación con conciliación del descanso.
¿Qué beneficios experimentamos con la práctica de Mindfulness «Conciencia Plena»?
El desarrollo de la conciencia plena nos permite centrarnos en el presente, olvidando los problemas del pasado y las preocupaciones por el futuro, logrando con la práctica diaria generar los siguientes beneficios:
- Mejora el equilibrio del Sistema Nervioso Simpático y Parasimpático
- Eleva el afecto positivo
- Sensación de satisfacción con la vida
- Mayor control de la atención
- Mayor conciencia de las experiencias internas y externas
- Menor reactividad a las experiencias
- Mejor regulación emocional
- Mayor flexibilidad Psicológica
Cuando practicamos la plena conciencia intensivamente, descubrimos que tenemos una necesidad de sueño más reducida; nos sentimos más frescos con menos horas de cama. A su vez si el luchar contra el insomnio nos mantiene precisamente despiertos, la plena conciencia con su hincapié en ACEPTAR cualquier cosa que ocurra en ese momento, tiende a desactivar esa batalla. Y por último, la práctica de plena conciencia nos ayuda a desprendernos de los pensamientos orientados a una meta y abordar las emociones difíciles.
Practicar las meditaciones de plena conciencia cuando vamos a la cama, nos permitirá descansar o identificar qué es lo que nos mantiene despiertos durante la noche, dejando de reforzar la lucha contra lo que acontece en dicho momento.
A partir de lo expuesto este tipo de enfoque brindara las herramientas que conjuntamente con la práctica diaria y el compromiso del paciente, le permitirá recobrar una mayor conciencia de su registro corporal y como efecto un mayor nivel de aceptación de lo que acontece en el momento presente aumentando el nivel de gratificación logrando un mejor descanso.
Estas estrategias de trabajo pueden ser empleadas para cualquier persona que quiera estar más PRESENTE en cada actividad que realiza y alcanzar una mayor armonía en su DESCANSO.
Fuente:
- Martí A., García –Campayo J., Demarzo M. “Mindfulness y Ciencia. De la Tradición a la Modernidad”. Alianza Editorial. Formato Digital (2014)
- Ronald D Siegel “La Solución MINDFULNESS -Prácticas cotidianas para problemas cotidianos -”
- Michael L Perlis – Carla Jungquinst – Michael T Smith – Donn Posner- “Insomnio: Una guía cognitiva conductual de tratamiento”
Audio completo: Exposición Mindfulness como herramienta para desarrollar una relación consciente y saludable con el descanso – Lic. en Psicología Verónica Cajen
Exploración Corporal PrácticaMEDITACIÓN DE LA RESPIRACIÓN CONSCIENTE “Comienzo por sentir mi postura sentada… siento los puntos de contacto con el suelo…Noto el movimiento que produce la respiración en mi cuerpo, focalizando mi atención en las fosas nasales y siento los efectos entrando y saliendo de esa zona del cuerpo y el cambio de temperatura, como el aire entra frío y sale un poco más caliente. Si noto que la atención se aleja de la respiración invito con amabilidad a volver a anclar a la respiración en la zona entre la nariz y el labio superior. No intento cambiar ni controlar, ni mejorar nada. Focalizo ahora la respiración en la zona del pecho, siento los efectos de esta en esa zona. Continúo observando el fluir de esta respiración, me doy cuenta que mi respiración ocurre en el presente. Observo como el pecho sube y baja. Ahora focalizo la respiración en la zona del abdomen. Observo y respeto cómo es cada momento. Observo cómo esta nueva zona del cuerpo se expande y sube. Nuevamente si mi mente se distrae la invito amablemente a volver. Sigo respirando… inhalo y me doy cuenta que estoy inhalando… exhalo y me doy cuenta que estoy exhalando. Mantengo mi mente abierta y libre para este momento presente. No buscamos que ocurra nada particular, sólo respiro.” Para volver al momento presente comienzo a mover levemente los dedos y con calma abro los ojos Audio Práctica Mindulness
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