Angeles University Foundation

College of Allied Medical Professions

Department of Physical Therapy

PRIMARY HEALTH CARE

November Batch 2021
Final Requirement

Submitted by:

Cunanan, John Keeper P.

Dueñas, Zildjian Gwen Dominique B.
Flores, Alecsandra Jeane B.
Magistrado, Leandrew T.
Mallo, Celine Kyla C.
Mangune, Alfred A.
Manlapaz, John Rey L.
Reyes, Ethan Albert P.
Suba, Ma. Arleni Clare M.

BSPT 4

Submitted to:
Carmelo C. Cunanan, Ph.D, PTRP
Angela Khristine Q. Malig, MPH, PTRP
Dominic S. Adolfo, PT, PTRP
Gianella Aleckz D. Argao, DPT, PT
Ruffin Stephanelle O. Punzalan, PTRP
Kathleen Kate Yumul, PTRP

PHC Preceptors

November 24, 2021

I. Webinar Title:
“PARA KANINO KA NATUTULOG?” Exercise your way Against Sleep Deprivation and
 Ways on Increasing Quality of Sleep this CoVid-19 Pandemic

II. Objectives
This project aims to promote and emphasize the importance of sleep especially
among adolescents or teenagers. It is expected that through this webinar, they may learn
to prioritize sleep and appreciate physical activity and exercise as a way to improve their
overall health and wellness. With this, not only will the target audience be less likely to
experience sleep deprivation and burn out that may reduce their learning capacity,
academic performance, and general health, they may also gain a wider perspective and
understanding of sleep and exercise that can cause positive behavior change while
promoting physical therapy.

III. Target Audience:

Teenagers/ Young adults (Senior High School Students)

IV. Webinar Details

A. Where: Google meet (https://meet.google.com/hpz-fcnc-xmo )
B. When: November 27, 2021 (Saturday), 10:00- 11:00 AM PHT
C. How: Registration Link (https://forms.gle/d32JDn7q88tRsu3N9) / QR Code

V. Division of Tasks
Role Person-in Charge

Program Hosts Manlapaz, John Rey

Duenas, Zildjian Gwen Dominique B.

Speaker Cunanan, John Keeper P.

Mangune, Alfred

Moderator Flores, Alecsandra Jeane B.

Multimedia/ Marketing Team Mallo, Celine Kyla C.

Suba, Ma. Arleni Clare M.

Content Editors Mallo, Celine Kyla C.

Suba, Ma. Arleni Clare M.

Evaluation Forms Reyes, Ethan Albert

 Letters Magistrado, Leandrew T.

VI. Program Outline

Activity Time Person-in-charge

Prayer/Introduction 10:00 AM - 10:05 AM Rey & Gwen

Leni (prayer)

Welcoming remarks 10:05 AM - 10:10 AM Sir Sean Ocampo

Games/ Ice Breaker 10:10 AM - 10:20 AM Rey & Gwen

Speaker 1 (How important rest is 10:20 AM - 10:35 AM Keeper

in a world where productivity is
everything)

Speaker 2 (Tips and advice on 10:35 AM - 10:50 AM Alfred

how to combat Sleep Deprivation
through exercises/ physical
activity)

QnA 10:50 AM - 10:55 AM Rey & Gwen

Closing Remarks and Awarding 10:55 AM - 11:00 AM Ma’am Gianella Aleckz

of Certificates D. Argao, DPT, PT

Rey & Gwen

VII. Poster and Meeting Background

VIII. Outline of Topics to be Discussed

PART 1: How important rest is in a world where productivity is everything
Introduction:

● Definition of Productivity, Sleep, Sleep Deprivation

Sleep- the natural state of rest in which your eyes are closed, your body is not active, and your
mind is not conscious (Collins Dictionary, 2018)

Sleep Deprivation- sleep deprivation is a general term to describe a state caused by inadequate
quantity or quality of sleep (Better Health Channel, 2021)

Connect why adequate sleeping/ resting is actually productive contrary to the

belief that reduced sleep time was often equated with increased productivity.

● Stages of Sleep (Sleep Foundation, 2020), (Brain Basics, 2021)

There are two basic types of sleep: rapid eye movement (REM) sleep and non-REM
sleep (which has three different stages). Each is linked to specific brain waves and neuronal
activity. You cycle through all stages of non-REM and REM sleep several times during a typical
night, with increasingly longer, deeper REM periods occurring toward morning.

➔ Non-REM sleep happens first and includes three stages. The last stage of non-REM sleep
is when you sleep deeply. It’s hard to wake up from this stage of sleep.
➔ REM sleep happens about an hour to an hour and a half after falling asleep. REM sleep is
when you tend to have vivid dreams.

NREM Stage 1: NREM Stage 2: Light NREM Stage 3: Deep REM Stage
Sleep Sleep

Transition period Body temperature Deepest sleep occurs Brain becomes more
from wakefulness drops & heart rate active
sleep begins to slow Blood pressure &
breathing to their Dreams occur
Lasts around 5-10 Brain wave activity lower levels
minutes slows but is marked Eyes move rapidly
by brief bursts of Muscles are relaxed
electrical activity Body is relaxed and
Commonly last for immobilized
Lasts approximately 20-40 minutes
10-25 minutes First occurs about 90
minutes after falling
asleep

● Sleep Guidelines: How Much Sleep Do We Really Need? (Sleep Foundation, 2021)
 Age group Recommended sleep hours

Newborn 0-3 months old 14-17 hours

Infant 4-11 months old 12-15 hours

Toddler 1-2 years old 10-13 hours

Pre-school 3-5 years old 9-11 hours

School age 6-14 years old 9-11 hours

Teen 14-17 years old 8-10 hours

Young Adult 18-25 years old 7-9 hours

Adult 26-64 years old 7-9 hours

Older Adult 65 or more years old 7-8 hours

● Importance of Adequate Sleep (Philstar, 2021)

Sleep is critical for the healthy development of teenagers and young adults, as well as to
their academic and professional success. In adolescents, insufficient sleep, inadequate sleep
quality, and irregular sleep patterns are associated with daytime sleepiness, negative moods,
increased likelihood of stimulant use, higher levels of risk taking behaviors, poor school
performance, and increased risk of unintentional injuries. A study has stated that a many
teenagers 15 to 18 years of age spend only four to six hours of sleep at night during the
pandemic.

Several factors contribute to lack of sleep in adolescence and young adulthood.

Insufficient sleep during this critical growth period arises from psychological, behavioral,
sociocultural, and environmental changes.
❖ Hormonal time shift & early school start times
❖ Hectic after-school schedule
❖ Leisure activities
❖ Light exposure
❖ Vicious cycle
❖ Social attitudes
❖ Sleep disorder

● Causes/Risk factors of Sleep Deprivation among Young Adults (Teenagers

and sleep - Better Health Channel, 2018)
○ Hormonal time shift – puberty hormones shift the teenager’s body clock
forward by about one or two hours, making them sleepier one to two hours
later. Yet, while the teenager falls asleep later, early school starts don’t
 allow them to sleep in. This nightly ‘sleep debt’ leads to chronic sleep
deprivation
○ Using screen based devices – smart phones and other devices used around
bed time reduce sleep time. Teens who put down their smart-phones an
hour before bed gain an extra 21 minutes sleep a night, (that's one hour
and 45 minutes over the school week) according to a study by Vic Health
and the Sleep Health Foundation)
○ Hectic after-school schedule – homework, sport, part-time work and social
commitments can cut into a teenager’s sleeping time
○ Leisure activities – the lure of stimulating entertainment such as
television, the internet and computer gaming can keep a teenager out of
bed.
○ Light exposure – light cues the brain to stay awake. In the evening, lights
from televisions, mobile phones and computers can prevent adequate
production of melatonin, the brain chemical (neurotransmitter) responsible
for sleep
○ Vicious circle – insufficient sleep causes a teenager’s brain to become
more active. An over-aroused brain is less able to fall asleep.
○ Social attitudes – in Western culture, keeping active is valued more than
sleep
○ Sleep disorder – sleep disorders, such as restless legs syndrome or sleep
apnoea, can affect how much sleep a teenager gets.

● Effects of Sleep Deprivation Among Adolescents & Young Adults (Persky,

2018) (Hershner & Chervin, 2014) (Söderström et al., 2012) (Kim et al., 2017)
(Anwar, 2018)
○ Students have trouble retaining information, coping with stress, and
staying focused. “These effects can have a serious impact on test scores
and on the grades students receive on class projects and papers”
○ Greatly increases the risk for motor vehicle accidents.
○ Sleep deprivation increases the risk for diabetes, obesity, and high blood
pressure
○ May experience clinical depression or anxiety, irritability, or lack of
motivation from sleep deprivation
○ Decreasing quality sleep results in loneliness and social rejection. UC
Berkeley researchers have stated that sleep-deprived students feel lonelier
and less engaged with others.
 ○ Sleep deprivation may result to impaired skin function. Findings show that
they are similar with those of previous studies that showed a decreased
skin function after 42 hours of sleep deprivation. This may lead to skin
dehydration.
○ The results indicate that insufficient sleep, preoccupation with thoughts of
work during leisure time, and high work demands are risk factors for
subsequent burnout.

● Sleep Disorders (CDC - Key Sleep Disorders - Sleep and Sleep Disorders, 2021)
❖ INSOMNIA - Insomnia is characterized by an inability to initiate or maintain sleep. It
may also take the form of early morning awakening in which the individual awakens
several hours early and is unable to resume sleeping. Difficulty initiating or maintaining
sleep may often manifest itself as excessive daytime sleepiness, which characteristically
results in functional impairment throughout the day. Before arriving at a diagnosis of
primary insomnia, the healthcare provider will rule out other potential causes, such as
other sleep disorders, side effects of medications, substance abuse, depression, or other
previously undetected illness. Chronic psychophysiological insomnia (or “learned” or
“conditioned” insomnia) may result from a stressor combined with fear of being unable
to sleep. Individuals with this condition may sleep better when not in their own beds.
Health care providers may treat chronic insomnia with a combination of use of sedative-
hypnotic or sedating antidepressant medications, along with behavioral techniques to
promote regular sleep.

❖ NARCOLEPSY - Excessive daytime sleepiness (including episodes of irresistible

sleepiness) combined with sudden muscle weakness are the hallmark signs of narcolepsy.
The sudden muscle weakness seen in narcolepsy may be elicited by strong emotion or
surprise. Episodes of narcolepsy have been described as “sleep attacks'' and may occur in
unusual circumstances, such as walking and other forms of physical activity. The
healthcare provider may treat narcolepsy with stimulant medications combined with
behavioral interventions, such as regularly scheduled naps, to minimize the potential
disruptiveness of narcolepsy in the individual’s life.
 ❖ SLEEP APNEA - Snoring may be more than just an annoying habit – it may be a sign of
sleep apnea. Persons with sleep apnea characteristically make periodic gasping or
“snorting” noises, during which their sleep is momentarily interrupted. Those with sleep
apnea may also experience excessive daytime sleepiness, as their sleep is commonly
interrupted and may not feel restorative. Treatment of sleep apnea is dependent on its
cause. If other medical problems are present, such as congestive heart failure or nasal
obstruction, sleep apnea may resolve with treatment of these conditions. Gentle air
pressure administered during sleep (typically in the form of a nasal continuous positive
airway pressure device) may also be effective in the treatment of sleep apnea. As
interruption of regular breathing or obstruction of the airway during sleep can pose
serious health complications, symptoms of sleep apnea should be taken seriously.
Treatment should be sought from a health care provider.

PART 2: Tips and advice on how to combat Sleep Deprivation through exercises/ physical activity
● Effects of Exercise to Sleep (Siengsukon et al, 2017)
A meta-analysis indicates that acute and chronic exercise has a moderate positive benefit
on sleep characteristics by increasing slow-wave sleep and total sleep time and decreasing sleep
onset latency.The exact mechanism of how exercise improves sleep characteristics remains
unknown. One theory is that exercise raises body temperature, which triggers heat-loss
mechanisms and leads to sleep onset. Another theory suggests that exercise uses energy and
produces “wear and tear” on the body, which leads to sleep to recuperate and restore energy. It is
also possible that exposure to bright light while exercising outside and the production of
inflammatory cytokines in response to exercise may influence sleep characteristics and sleep
quality. Changes in depressive symptoms, improvements in physical function, and weight loss
have also been associated with improvements in sleep due to exercise.

Sleep hygiene education typically includes the recommendation that exercise be

conducted in the morning or early afternoon but not in the evening due to evidence that an
increase in body temperature too close to bedtime interferes with the natural decline in body
temperature that occurs in the evening and as sleep mechanisms are initiated. However, the
interference of sleep by late-night exercise may depend on several factors, including the
individual's level of fitness and whether the individual has a sleep issue or not. According to the
2013 Sleep in America poll, there were no differences in sleep outcomes between individuals
who performed vigorous or moderate activity within 4 hours of bedtime and those who
performed vigorous or moderate activity more than 4 hours before bedtime. Therefore, the
recommendation, according to the poll, is that “exercise is good, regardless of time of day.”
However, this recommendation should be considered on an individual basis. Some studies have
found that just one 30-minute workout of moderate-intensity aerobic exercise can improve sleep
that very night. While others suggest that it takes longer for the effects of exercise to positively
impact sleep. The most important thing, probably even more important than the intensity of your
workout or the length of time you spend doing it, is to commit to exercising on a regular basis.
Just 30 minutes of low-intensity exercise, such as walking or doing housework, can help you
sleep better.

Meditative movement, including tai chi, qi gong, and yoga, also appears to improve sleep quality
in a variety of populations, but two recent systematic reviews suggest that more rigorous studies
are needed to demonstrate efficacy of these types of exercise to improve sleep quality and
characteristics

● Implications to PT (Siengsukon et al, 2017)

Positioning
Physical therapists should consider educating patients about appropriate positioning for sleep
considering the patients’ diagnoses as well as addressing impaired bed mobility if needed. Pain is
often cited as a contributing factor to poor sleep quality, so it is likely that education about
positioning for sleep in a pain-free or pain-reduced position may limit sleep disruption for these
individuals. For example, an individual with low back pain may benefit from instruction to sleep
side-lying with a pillow between his knees or to sleep supine with pillows under his knees to
reduce the lordosis of the back. Also, if a patient has difficulty with transfers and bed mobility,
the therapist should address the underlying impairments causing the functional deficits. Adequate
bed mobility is needed to change position while sleeping, and improved ease with changing
position with sleep may reduce sleep disruptions. Research demonstrating the effectiveness of
PT interventions on addressing sleep issues in patients seeking PT services is lacking and is an
area that warrants further investigation.

Stretching Before Bed (Zwarensteyn, 2021)

A healthy adult should remain in each stretch for a minimum of 60 seconds. In the event you
cannot hold the stretch for a full minute, they recommend doing several repetitions. For example,
if you’re only able to do a stretch for 30 seconds, repeat that same stretch for another 30.
Benefits: Reduces stress, improves blood flow, relieves muscle tension, helps with lower back
pain.
● Knee to Chest
● Spinal Twist
● Side Stretch
● Lunge
● Butterfly Pose
● Child’s Pose
● Bear Hug
● Legs Up the Wall

● Sleep Hygiene Education (Siengsukon et al, 2017)

IX. Evaluation Form for webinar
Link: (to follow)
X. Certificates for Speakers and Attendees
A. Speakers-
https://drive.google.com/file/d/1wVippOR46wYQYufHg6qqIRtSorZ4TMwk/vie
w?usp=sharing
B. Attendees-
https://drive.google.com/file/d/1rt2bpJyhBGNn3KkJ_nnC7csm44tuICAP/view?
usp=sharing

XI. References:
● Definition of sleep. (2018). Collinsdictionary.com; HarperCollins Publishers Ltd.
https://www.collinsdictionary.com/dictionary/english/sleep#:~:text=Sleep%20is%20the
%20natural%20state,exhausted%20from%20lack%20of%20sleep
● Siengsukon, C. F., Al-dughmi, M., & Stevens, S. (2017). Sleep Health Promotion:
Practical Information for Physical Therapists. Physical Therapy, 97(8), 826–836.
https://doi.org/10.1093/ptj/pzx057
● Stages of Sleep - Sleep Foundation. (2020). Retrieved 21 November 2021, from
https://www.sleepfoundation.org/how-sleep-works/stages-of-sleep
● Brain Basics: Understanding Sleep | National Institute of Neurological Disorders and
Stroke. (2021). Retrieved 21 November 2021, from
https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-
Sleep#4
● Filipino teenagers losing sleep during pandemic, student thesis shows. (2021, September
18). Philstar.com; Philstar.com.
https://www.philstar.com/lifestyle/2021/09/18/2128153/filipino-teenagers-losing-sleep-
during-pandemic-student-thesis-shows
● Persky, M. (2018, March 30). The Effects of Sleep Deprivation on High School Students
– Young Scientists Journal. Ysjournal.com. https://ysjournal.com/the-effects-of-sleep-
deprivation-on-high-school-students/
● ‌Hershner, S., & Chervin, R. (2014). Causes and consequences of sleepiness among
college students. Nature and Science of Sleep, 73. https://doi.org/10.2147/nss.s62907
● ‌Söderström, M., Jeding, K., Ekstedt, M., Perski, A., & Åkerstedt, T. (2012). Insufficient
sleep predicts clinical burnout. Journal of Occupational Health Psychology, 17(2), 175–
183. https://doi.org/10.1037/a0027518
● Kim, M. A., Kim, E. J., Kang, B. Y., & Lee, H. K. (2017). The Effects of Sleep
Deprivation on the Biophysical Properties of Facial Skin. Journal of Cosmetics,
Dermatological Sciences and Applications, 07(01), 34–47.
https://doi.org/10.4236/jcdsa.2017.71004
● ‌Anwar, Y. (2018, August 22). How poor sleep can ruin your social life. University of
California. https://www.universityofcalifornia.edu/news/poor-sleep-can-literally-kill-
your-social-life
● ‌Teenagers and sleep - Better Health Channel. (2018). Vic.gov.au.
https://www.betterhealth.vic.gov.au/health/healthyliving/teenagers-and-sleep#causes-of-
teenage-sleep-deprivation
● ‌How Much Sleep Do We Really Need? | Sleep Foundation. (2021, March 9). Sleep
Foundation. https://www.sleepfoundation.org/how-sleep-works/how-much-sleep-do-we-
really-need
● CDC - Key Sleep Disorders - Sleep and Sleep Disorders. (2021).
https://www.cdc.gov/sleep/about_sleep/key_disorders.html
● ‌Catherine F. Siengsukon, Mayis Al-dughmi, Suzanne Stevens, Sleep Health Promotion:
Practical Information for Physical Therapists, Physical Therapy, Volume 97, Issue 8,
August 2017, Pages 826–836, https://doi.org/10.1093/ptj/pzx057
● ‌Zwarensteyn, J. (2021). 8 Stretches for Your Best Night’s Sleep | Sleep Advisor.
Retrieved 24 November 2021, from https://www.sleepadvisor.org/stretching-before-bed/
● National Adolescent and Young Adult Health Information Center
(2014).Sleep Deprivation in Adolescents and Young Adults. San
Francisco: University of California, San Francisco.
Retrieved from: http://nahic.ucsf.edu/wp-content/uploads/2014/08/sleep-
brief-final