Veteran Sleep Therapy and Wellness Center

MANHATTAN SLEEP THERAPY AND WELLNESS CENTER Fall 2014 IAPD Capstone Studio Professor Vibhavari Jani Rudy Date

WHAT IS SLEEP? Definition

Sleep Cycles:

“A condition of body and mind such as that which typically recurs for several hours every night, in which the nervous system is relatively inactive, the eyes closed, the postural muscles relaxed, and consciousness practically suspended”

Rapid Eye Movement (REM) Sleep:

Characteristics: • Period of reduced activity • Decreased responsiveness to external stimuli • State of reduced consciousness (easy to reverse)

Physiological Changes: • • • •

Reduction in brain activity (in cycles) Reduction of body temperature Regulation of respiration Reduction in heart rate

• • • •

Rapid movement of eyes Dreams Increase in heart rate / brain activity / breathing last ten minutes - an hour

Non-Rapid Eye Movement (NREM) Sleep • N1 - Light sleep • N2 - Transitional phase • N3 - Deep ‘slow-wave’ Sleep

CONDITIONS AND TREATMENT

PTSD RELATED SLEEP DISORDERS Insomnia • Difficulty falling or staying asleep

Nightmares Periodic Limb Movement Disorder • • • •

Possibly caused by antidepressant Rhythmic movement of the limbs during sleep Typically involves the legs Fluctuations in severity - potentially very harmful

REM Behavior Disorder • Phyiscally act out dreams • Often violent • Lack of muscle paralysis

Maladaptive Stress • • • •

Sustained flight or flight response Associated with chronic increase in cortisol Exhaustion phase is equally as dangerous Depression, PTSD, Chronic Fatigue Syndrome are manifestiations of hypercortisolism • Hypervigilance / hyperarousal

TREATMENTS Cognitive Behavioral Therapy for Insomnia (CBT-I) • • • • •

Comprehensive sleep education Change sleeping habits Involves regular visits to a clinician/center Sleep assesments (written and tested) Sleep diary

Image Rehearsal Therapy • A type of exposure therapy • Aimed at reducing nightmares • Attemps to ‘rescript’ nightmares’ endings

Pharmacotherapy Relaxation Therapy Mindfulness-Based Strategies • Primary goal is stress reduction • Generally an eight-week group program

STATISTICS Poor sleep quality is the most common concern of veterans with PTSD (74-90%) Most common psychological comorbidities: mood disorders (90.1%) and substance abuse (73.5%) Sleep restoration is shown to improve in daytime symptoms Sleep is directly involved in PTSD-relevant emotion and memory processes Veteran preferences: • Relaxation therapy (72%) • Pharmacotherapy (56%) • Mindfulness Strategies (50%)

Veteran delivery preferences: • Individual • Internet • DVD

Primary concern for having to ‘attend’ a rehabilitation center is the time commitment

PRECEDENT ANALYSIS

REHAB BASEL Center for Spinal Cord and Brain Injuries Herzog and De Mueron Site and Orientation

Size: Land area: Net area: Gross floor area:

24,000 m2 12,000 m2 20,000 m2

Facilities: 2 wards for Paraplegics: 3 wards for Brain Injured: 1 intesive care monitoring station: Outpatient day hospital Training flats Hippotherapy

36 beds 48 beds 8 beds

Goals: Must not look or feel like a hospital:

Unlike a stereotypical hospital, it cannot have long, repetitive corridors; each floor with the same layout; waiting lounges next to the elevator and the end of a hallway.

Layout akin to a small town:

Streets; Plazas; Gardens; Zoning; Autonomy in patient selection of circulation;

Emphasis on patient lifestyle and wellness:

Patients should be as independent as possible and should see a continuous improvement of quality of life.

N

0

100ft

Connection to nature:

Rectangular courtyards allow light to pentetrate into hallways and corridors.

REHAB BASEL Center for Spinal Cord and Brain Injuries Herzog and De Mueron Spatial Organization Plan

Functions 17

20

17

20

17

17

17

17 19 18

17

10

17

11

13

12

14

15 16

9 6 8

7

4

5

1

2

3

Entrance Courtyard Outpatient Rooms Day Hospital Cafeteria Administrative Offices Reception Neuropsychology Occupational/Speech Therapy 9. Therapy Pool 10. Physiotherapy 11. Multipurpose Space 12. French Garden 13. Intensive Care 14. Medical Services 15. Diagnostics 16. Courtyard with pool 17. Patients’ bedrooms 18. Services 19. Offices 20. Lounge/dining

Circulation

Mass/Void

Second Floor

Second Floor

First Floor

First Floor

1.

2.

3.

4.

5.

6.

7.

8.

REHAB BASEL Center for Spinal Cord and Brain Injuries Herzog and De Mueron Patient Room Section Overhang Sliding Door Balustrade Wood Deck

Joinery

Repetition Skylight Green Roof

REHAB BASEL Center for Spinal Cord and Brain Injuries Herzog and De Mueron

SITE VISITS

KANSAS REHABILITATION HOSPITAL Topeka, KS

KANSAS REHABILITATION HOSPITAL Outdoor Physical Therapy Course

KANSAS REHABILITATION HOSPITAL Hallway Typical

KANSAS REHABILITATION HOSPITAL Storage OverямВow

KANSAS REHABILITATION HOSPITAL Examination Area

KANSAS REHABILITATION HOSPITAL Physical Therapy Pool

KANSAS REHABILITATION HOSPITAL Physical Therapy Gym

KANSAS REHABILITATION HOSPITAL On-Site Notations: The first thing clients want to see - a chair

40 - 50 staff members on average

Smoking areas are absoulutely necessary

Strength in numbers - ‘Do not isolate them.’

Cameras in the parking lots are necessary

Private staff restroom would be beneficial

Communcal kitchen (for staff) works quite nicely

Clients interact with approximately 6 different people daily

Furniture with 300 lbs weight min.

Biggest desired change: increase natural lighting and exterior views

For the physical therapy gym - overhead tracking would be a dream come true Views outside are critical Low, calm lighting in gym and therapy areas Office spaces meed more storage room Admittance rooms need to be completely secure Flexibility in spaces is critical (Seating) Furniture cannot be on wheels 8’ Hallways Extension cords are not allowed - outlets everywhere

IRWIN ARMY COMMUNITY HOSPITAL Fort Riley, KS

IRWIN ARMY COMMUNITY HOSPITAL Existing Physical Therapy Gym

IRWIN ARMY COMMUNITY HOSPITAL Existing Occupational Therapy Area

IRWIN ARMY COMMUNITY HOSPITAL Proposed Examination Room Spaces

IRWIN ARMY COMMUNITY HOSPITAL Proposed Examination Room

IRWIN ARMY COMMUNITY HOSPITAL On-Site Notations: Concep is a mall - ‘on-stage’ vs. ‘off-stage’ Technician’s view of patients/clients is critical Storage space is always an issue Generally, check-in and check-out sequences occur in different spaces Random patient got lost once, had to be show the way out don’t let that happen Everyone gets excited about windows Most commonly used spaces in center and on main floor Two sets of window blinds - one for glare, one for blackout ‘Cleanability’ of materials is very important Two room numbers for every room - architectural number + general wayfinding number Keys + Zones with ID badge + PIN number (little black box)

SITE ANALYSIS

PROXIMITES

te) a v i r P ( ial t n e d i s Re

lic) b u P ( l cia r e m m Co

CLIMATE The climate in this area lies in a transition zone, exposing it to hot humid summers and cold dry winters. Being in this transition zone puts Kansas in what’s known as tornado alley.

Also shown is a graph charting the average wind speed and total precipitation for each month over the course of one year. Wind speeds are highest during the spring, while percipiation is highest during the winter, and in the month of June.

Manhattan’s extreme temperatures have ranged from 116 degrees (August 1936) and -35 degrees (February 1899). On average, Manhattan’s yearly rainfall is around 36” and records 102 days of measurable rain.

Wind Speed + Precipitation

Temperature Value

Manhattan, KS

Manhattan, KS 120 Highest Temperature Mean Temperature Lowest Temperature

80 60 40 20 0

12

10

10

8

8

6

6

4

4

2

2

0

-20 September 2013

Value

Temperature (F)

100

12

December

March

Month

June

September 2013 December

0 March

Month

June

Average Wind Speed (mph) Precipitation Total (in.)

SUN AND LIGHT

SUN AND LIGHT

CONCEPTUAL DEVELOPMENT

IDEATION

IDEATION CLARITY

IMPLIED CONTINUITY

DIRECT CONTINUITY

G

t db C

S

CONCEPT: CONTINUITY

Cyclical Consistent Repetitive Balanced

GOALS Emphasis on patient lifestyle and wellness:

Patients should be as independent as possible and should see a continuous improvement of quality of life.

Connection to nature:

Courtyards allow light to pentetrate into hallways and corridors.

Achieve hollistic healing:

The center must treat healing as an extension of the client’s mind, body, and soul.

Cater to the public and appeal to the community:

The outpatient should double as a connection point to the community and should be accesible by the public as much as possible.

PROGRAMMATIC REQ’S Sheet1

Spaces

Minimum Sq. Ft.

Adjacency

Acoustics

Lighting

Color

Materials

Privacy (1 – Most Public; Design Factors 5 – Most Private)

Standard acoustics; not necessarily overly quiet

Warm, inviting; mostly warm colors luxury materials – ambient lighting; daylit; wood/stone/granite counter decorative lighting potential warm colors luxury materials – warm, calm; mostly ambient; properly daylit wood/stone (adjustable); decorative lighting potential

1

utilitarian

neutral

easily cleanable surfaces – tile, solid countertops

4

utilitarian

neutral

easily cleanable surfaces – tile, solid countertops

4

needs to very well lit; task lighting

neutral

Utility Reception

Waiting Area

250-350 sq.ft.

Closest to waiting area; close to patient entry; near 'intake' exam rooms 300-350 sq. ft. (6-8ppl) Closest to Reception and patient entry; close to public bathrooms?

Staff Bathrooms

12' x 17'

Patient Bathrooms

12' x 17'

Server/Storage/Janitorial

9'6” x 7'6”

Staff Breakroom

16' x 16'

Standard acoustics; not necessarily overly quiet

closest to offices and typ bathroom breakroom; away from patient access central to various patient- typ bathrooms centric spaces: exam rooms, classrooms, therapy rooms away from all patientcentric spaces; close to staff bathrooms closest to offices and bathrooms and storage; inaccessible to patients

N/A

needs to good acoustics to well lit – mostly ambient keep running lighting water/microwave/conversatio n under control

basic, sustainable, financially responsible materials warm colors tile by the kitchenette, carpet/luxury flooring

1

4

4

Reception Desk needs to be secure; views out to the garden need to consider prospect and refuge in arrangement of furniture

needs to be secure and relatively inaccessible to patients easy access for staff, difficult access for patients; doubles as staffonly meeting room

Outpatient Examination Rooms

10' x 12'

clustered around therapy relatively quiet, soundproof and laboratory; easy access from reception area

Cool; adjustable lighting for cool various scenarios

Therapy Rooms

12' x 15' (Biofeedback Room – 11' x 12.5' x 12')

clustered around examination and laboratory; farthest from front entrance

Sleep Lab

15' x 15'

closer to therapy rooms Extremely soundproof; than exam rooms; close patients should be able to to staff offices; away from stay asleep for a while public spaces; preferably close to storage

very well lit, plenty of task lighting as well

neutral

8' x 10' (min)

clustered with other staff- acoustics are not as much of plenty of ambient lighting, centric spaces; somewhat an issue as staff will plenty of options for task close to examination primarily be working lighting rooms independently in their office

neutral

very quiet – patients should Cool, calm, relaxing; be able to fall asleep adjustable (dimmable) lighting for various scenarios; adjustable daylight

4

technician should be close to door, patient far from door; visual barrier between patient and tech's info

5

very comfortable furniture;

typical lab materials – easily cleanable, sanitary, solid surfaces

5

Very comfortable furniture; namely beds

luxury materials – wood desk, solid wood/stone floors, comfortable furniture;

4

soft materials – carpet, furniture with cushions, leather

cool, relaxing

Meeting Offices

Page 1

PROGRAMMATIC REQ’S Sheet1 Multipurpose rooms

10' x 12' – 20' x 25'

Classrooms

25' x 25'

central to many activities; multiple, flexible entrances closer to the exterior; views of the outside; farther from the private spaces; closest to the library

adaptable acoustics – not too quiet in small groups, not too loud in large groups adaptable acoustics – not too quiet in small groups, not too loud in large groups

adjustable lighting for various activites – task lighting near tables adjustable lighting for various activites – task lighting near tables; plenty of daylight

transitional from warm to cool transitional from warm to cool

soft materials – carpet, furniture with cushions, leather materials with easy maintenance

2–3

2

furniture specs should be very flexible and easy-touse flexible, sturdy furniture

Specialty Library

25'x25' minimum (could Two-story height, very needs very good acoustics be much larger) open; views of the to combat double height exterior/garden; closest to space; classrooms, cafe, and computer lab

mostly adjustable daylight; warm colors soft, acoustic, luxury plenty of warm ambient and materials task lighting (for reading);

2

needs spaces for a variety of group sizes, as well as individual reading stations/computers

Garden

N/A

completely exterior space, possible green roof; closest to cafe and parking lot;

nighttime decorative lighting green that doesnt interfere with plant growth

1

should serve as a visual barrier between site and views off-site

Computer Lab

25' x 25'

closest to library and cafe Standard acoustics; not necessarily overly quiet

Glare-free, warm lighting

2

Furniture configuration: pods? Rows? Perimeter?

N/A From impression from offsite; closest to garden and front facade can be more public than N/A patient entry; closest to the side street and other buildings/tenants; relatively far from patient entry

N/A nightime lighting must be adequate – increase safety

N/A

1

circulation is critical

N/A nightime lighting must be adequate – increase safety

N/A

1–3

interior/exterior interior portion must have connection; closest to good acoustics library and part of parking; close to garden?

views out/porch views; mostly daylit; closed at night

easily found from offsite; N/A closest to the garden and front facade;

N/A nightime lighting must be adequate – increase safety; potential for decorative lighting (signage)

N/A

Eco-friendly materials

transitional Heat-resistant (computer from warm to generate a lot of heat) cool

Exterior Parking

Staff Entry

Cafe

Patient Entry

15' x 20' + Exterior

Page 2

warm colors soft (interior); weatherresistant (outside)

N/A

accessability/security (keycard gate?) is as important as circulation

1

outside portion should be secure when closed.

1

wayfinding and signage from off-site is critical; adequate handicapped spots; security and views from offsite is important

PROCESS

MIDCRITS Terrace Garden

Courtyard

Staff Breakroom

Library

Open to Below Comp.

Lab Terrace Garden

Cafe

First Floor

Second Floor

Green Spaces

Specialty Rooms

Examination Rooms

Multi-functional Spaces

Therapy Rooms

Offices

DEVELOPMENT

DESIGN DEVELOPMENT

SITE PLAN

LEAVENWORTH ST. A

HUMBOLDT ST.

N

D

5th ST.

C

6th ST.

A: DAYCARE B: PHARMACY C: GYM D: COPY CENTER E: VFA OFFICE

B

E

FLOOR PLAN FIRST FLOOR

N

ZONING FIRST FLOOR CAFE BATHROOMS

LIBRARY

RETAIL RECEPTION

RECEPTION

COURTYARD GARDEN

CLASROOMS

COMPUTER LAB

EXAMINATION ROOMS

FURNITURE PLAN FIRST FLOOR

FLOOR PLAN SECOND FLOOR

N

ZONING SECOND FLOOR

LIBRARY

TERRACE GARDEN

RECEPTION

RECREATIONAL ROOM

SLEEP THERAPY ROOMS

OFFICES

BREAK ROOM ARCHIVES

FURNITURE PLAN SECOND FLOOR

LONGITUDINAL SECTION

EAST ELEVATION

SOUTH ELEVATION

WEST ELEVATION

FURNITURE DESIGN Furniture Development: An embellishment of the sterotypical banquette seating casework, this furniture piece aims to combine the concept of continuity with hollistic healing.

With its abnormally large wood-paneled backing, the piece aims to achieve visual continuity and seamlessly connect the ground plane and ceiling plane. As opposed to a cheap, veneer finish, the casework is constructed with actual planks of wood. Along the back panel, small gaps are intentionally left between planks of wood. The panel is then internally backlit, in order to visually convey a sense of ascension and, through it, mental healing.

The portion of the casework that actually serves as seating is designed to be optimally ergonomic, in order to ensure comfort and promote physical health.

The material selection is equally as important. Wood is used because it can easily be ergonomically shaped and, although rigid, conveys a sense of natural warmth. Additionally, wood can be harnessed through a variety of sustainable methods.

Selenite, the crystallic material used for the side panels, is also an abundant and sustainable material, and posseses a unique optical characteristic not found in typical glazing. Often called nature’s fiberoptic cable, light transmittance through selenite can provide a variety of soothing yet dynamic views.

Moreover, selenite is commonly associated with mental and spiritual clarity in dark times, due to it’s optical resemblance to the moon. Most often shaped in sheets, selenite is a very easy material to work with.

Through the combinatin of form, materiality, and integrated lighting, the furniture aims to portray a sense of continuous healing.

PRODUCT DESIGN Product Development: Designed as an extension of the common pendant light (Visa Lighting - Aries series), this product is specifically for use in a sleep therapy room.

For the most part, it functions similar to a ceiling-hung pendant light. Unlike most lighting, however, it has three modes of operation. While the ‘on’ and ‘off’ modes operate as expected, there is an extra mode, called ‘sleep’ mode, that is used during sleep therapy sessions.

In ‘sleep’ mode, the light dims over a period of approximately 20 minutes., by default. The length of this dimming period is crucial to easing the clients into ideally restorative sleep. It takes about 20 minutes for the sun to cross the horizon when setting or rising. It also takes upto to 20 minutes for human eyes to completely adjust to a drastically different lighting scenario.

20 minutes might not the be the right time span for everyone, however. Therefore, the dimming capabilities and length can be programmed via bluetooth by select physicians and therapists.

After the light has dimmed, it uses a combination of motion and sound sensors to determine the amount of time the client spent in non-active sleep. Additionally, by utilizing a separate, low-emitting bulb, the lamp takes advantage of its circular form and provides a real-time updated, simple pie-chart-shaped display showing how long the client slept that session as a fraction of an optimal night’s sleep. All of these functions can be customized or overridden by the physician or therapist through integration with smartphones.

Typical ‘on’ mode

The low-light bulb also doubles as a night-light. Many times, waking up from a nightmare or experiencing any of the symptoms of sleep disorders is a fairly violent, sudden movement.

When awoken so suddenly, the night-light provides a sense of space and security in an otherwise dark room.

The idea is that, over time, the client, immediately after waking up, will be given a visual reminder of his/her progress in his/her sleeping patterns, simply by looking at the ceiling light.

‘Sleep’ mode showing sleep cycle progess

DIAGRAMS

GEOMETRY

The angle for the breezeway (and other characteristics in was not an arbitrary one. It is the angle made by the 9a.m. and 6p.m. points on a sun chart of the site’s exact latitude and longitude.

9 - 6 also represents a 9 hour block of time, which is considered the optimal amount of time for a standard night’s sleep for the healthy adult.

9.am. and 6p.m. symbolize a variety of relevant factors. 9 - 6 is a stereotypical workday for the average civilian and represents my goal to get veterans reintegrated into civilian life.

The staircases were constructed as a perfect mirror to the angle of the breezeway, symbolizing the small amount of polar opposite necessary to keep balance.

SOUTH FACING SHADING

CIRCULATION

PUBLIC CIRCULATION CLIENT CIRCULATION FIRE CODE EGRESS

VISUALIZATIONS

BIBLIOGRAPHY 1. Babson, K., Blonigen, D., Boden, M., Drescher, K., & Bonn-Miller, M. (2012). Sleep Quality Among U.S. Military Veterans With PTSD: A Factor Analysis and Structural Model of Symptoms. Journal of Traumatic Stress, 25, 665-674.

2. Epstein, D., Babcock-Parziale, J., Haynes, P., & Herb, C. (2011). Insomnia treatment acceptability and preferences of male Iraq and Afghanistan combat Veterans and their healthcare providers. Journal of Rehabilitation Research and Development, 49(6), 867-878.

Retrieved December 15, 2014, from ProQuest.

3. Germain, A. (2013). Sleep Disturbances as the Hallmark of PTSD: Where Are We Now? The American Journal of Psychiatry, 170(4), 372-82. Retrieved December 15, 2014, from ProQuest.

4. Grossman, P. (2003). Mindfulness-based Stress Reduction And Health Benefits: A Meta-analysis. Journal of Psychosomatic Research, 57, 35-43.

5. Harb, G., Thompson, R., Ross, R., & Cook, J. (2012). Combat-Related PTSD Nightmares and Imagery Rehearsal: Nightmare Characteristics and Relation to Treatment Outcome. Journal of Traumatic Stress, 25, 511-518.

6. Healthy Sleep. (2014, January 1). Retrieved December 15, 2014, from http://healthysleep.med.harvard.edu/healthy/ 7. REM Behavior Disorder and Sleep. (2014, January 1). Retrieved December 15, 2014, from http://sleepfoundation.org/sleep-disorders-problems/rem-behavior-disorder 8. Schoenfeld, F. (n.d.). Treatment of sleep disturbances in posttraumatic stress disorder: A review. JRRD, 49(5), 729-752.

9. Tull, M. (2013, September 3). Image Rehearsal Therapy. Retrieved December 15, 2014, from http://ptsd.about.com/od/glossary/g/IRTDef.html 10. What Happens When You Sleep. (2014, January 1). Retrieved December 15, 2014, from http://sleepfoundation.org/how-sleep-works/ what-happens-when-you-sleep