​​​ Dr. Jaan Reitav
Clinical and health psychologist Dr. Jaan Reitav, who has  a post-doctoral certification in behavioural sleep medicine, is a staff psychologist at Toronto Rehab Institute's Cardiovascular Prevention and Rehabilitation Program.​ (Photo: UHN)

Daylight saving time never fails to remind us how an hour of lost sleep can change the way we feel and function.

Patients with chronic conditions such as heart disease should pay attention to the quality of their sleep, since, without the proper rest, they could be putting additional stress on their bodies.

Sleep is vital to our health whether we are healthy, recovering from an acute medical condition, or managing a chronic one.

To learn more, UHN caught up with Dr. Jaan Reitav, a clinical and health psychologist with a post-doctoral certification in behavioural sleep medicine, and a staff psychologist at Toronto Rehab Institute's Cardiovascular Prevention and Rehabilitation Program.

​Q&A with Dr. Jaan Reitav 

UHNews: What is the role of a psychologist in the cardiovascular prevention and rehab program?

Dr. Reivav: I work with heart patients to help them understand that lifestyle patterns (such as high stress, poor diet, and poor sleep) are not only important risks to their health, but also ones that they can change to reduce future risks for new heart problems.

As patients progress through their rehabilitation, a psychologist can help them find ways to begin making meaningful and lasting changes. Initially, they may have to deal with obstacles that prevent them from taking those necessary steps.

An important part of treatment involves patients learning how to be more aware of their stress fingerprint. Stress can produce many changes in the body from the cellular level to ones that patient can feel directly, such as increased heart rate, irritability, and lack of mental focus. Across the program they learn skills to start reducing that stress. Through a variety of mind-body techniques, I teach patients how to control their body's stress reactions.​

Not getting enough sleep can take a toll
Not getting enough sleep can take a toll. (Photo: code_martial/Flickr)

UHNews: What is the link between stress and poor sleep?​

Dr. Reivav: Chronic stress creates a state of hyperarousal. You will feel edgy, notice that you are very reactive to noises, or other surprises, and your thoughts may be harder to focus, or more negative. In this "alert" stage, you are more vigilant to danger that you feel may be out there.

Heightened stress arousal is a brain state that continues into sleep, fragmenting sleep and making it harder to awaken rested. Your biological sleep rhythm is not an eight hour block of sleep, but a series of short blocks of 90-minutes each. At the end of each of these blocks you are in a state much closer to awakening.

When you are stressed, the presence of that elevated background stress state is enough to awaken you, to check for any danger. It's how our brain has been programmed to put survival ahead of good sleep. When you are highly stressed, even these 90-minute blocks are interrupted by your stress system.

UHNews: Can patients with other chronic health conditions benefit from better stress management and sleep?

Dr. Reivav: That is what we are most excited about. This program was designed to meet the needs of heart patients to reduce their stress levels, but as the program grew in popularity, patients with breast cancer, stroke, and diabetes have come, and all have had similar benefits. This is another aspect of our research interests. We have a lot of work ahead of us, but it looks like taking the approach of teaching patients behavioural skills to help them reduce their stress reactions was a focus that has broader applicability.

UHNews: What about someone who is in good health right now?

Dr. Reivav: I run a program in the community called 7 Easy Steps to Less Stress and Better Sleep. Referrals come from doctors and sleep clinics, mainly for patients with chronic sleep problems but who are otherwise healthy. This behavioural neuroscience approach to changing brain behaviour has benefited these patients enormously.

In fact, I think that the most valuable result of my program is that the skills and strategies provided to participants give them increased resilience and quite likely will help prevent, or delay, some of the chronic medical problems that show up at our hospital.​

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