Sleep Hygiene

Behavioral Strategies for Managing Symptoms

• is a simple, effective, but often underutilized method for addressing sleep disturbances

Sleep Hygiene Practices:

• Consistent Sleep Schedule (Circadian Rhythm):
  • Maintain a regular sleep-wake cycle by going to bed and waking up at the same time every day, even on weekends.
  • Studies have shown that maintaining a regular sleep-wake schedule helps regulate the body’s internal clock, optimizing the circadian rhythm. Disruptions to this schedule, such as irregular sleep patterns on weekends, can lead to sleep difficulties.
• Optimal Sleep Environment:
  • Ensure the sleep environment is comfortable, dark, quiet, and cool.
  • Use a comfortable mattress and pillows to support proper body alignment.
  • Research suggests that a comfortable and conducive sleep environment, including factors like darkness, quietness, and cool temperatures, can positively impact sleep quality. Disruptions in the sleep environment, such as excessive noise or light, may interfere with sleep.
• Limit Stimulants:
  • Avoid stimulants such as caffeine and nicotine, particularly in the hours leading up to bedtime.
• Regular Exercise:
  • Engage in regular physical activity, but avoid vigorous exercise close to bedtime.
• Limit Naps:
  • If napping, keep it short (20-30 minutes) and avoid napping late in the day.
• Healthy Diet:
  • Maintain a balanced diet, and avoid heavy meals close to bedtime.
• Screen Time and Blue Light:
  • Limit exposure to electronic devices emitting blue light before bedtime, as it can interfere with the production of the sleep hormone melatonin.
• Mindfulness and Relaxation Techniques:
  • Practice relaxation techniques, such as deep breathing, meditation, or progressive muscle relaxation, to reduce stress and promote a calm state before bedtime.
• Limit Liquid Intake Before Bed:
  • Minimize the consumption of fluids close to bedtime to reduce the likelihood of waking up for bathroom trips.
• Establish a Bedtime Routine:
  • Develop a pre-sleep routine to signal to the body that it is time to wind down.

Other:

1. Stress Management Techniques:
   • Mindfulness and Meditation: Encourage practicing mindfulness meditation to reduce stress and improve emotional regulation.
   • Deep Breathing Exercises: Teach Sofia techniques like diaphragmatic breathing to help calm her mind and body.
   • Progressive Muscle Relaxation: Suggest progressive muscle relaxation exercises to reduce physical tension.
2. Physical Activity:
   • Regular Exercise: Recommend engaging in moderate physical activity, such as walking, swimming, or yoga, for at least 30 minutes most days of the week. However, advise avoiding vigorous exercise close to bedtime.
3. Cognitive Behavioral Techniques:
   • Cognitive Behavioral Therapy for Insomnia (CBT-I): Consider referring Sofia to a therapist trained in CBT-I, which is effective for treating chronic insomnia by addressing negative thoughts and behaviors related to sleep.
   • Challenging Negative Thoughts: Encourage Sofia to identify and challenge negative thoughts that may be contributing to her feelings of fatigue and distress.
4. Time Management and Prioritization:
   • Pacing Activities: Help Sofia to pace herself and prioritize her tasks to avoid overexertion and manage her energy levels better.
   • Setting Boundaries: Discuss the importance of setting boundaries at work and home to prevent burnout and ensure she has time for self-care.
5. Social Support:
   • Seeking Support: Encourage Sofia to talk to her partner, family, and friends about her feelings and seek their support.
   • Support Groups: Suggest joining support groups, either in-person or online, where she can share her experiences and learn from others facing similar challenges.
6. Diet and Nutrition:
   • Healthy Eating Habits: Advise Sofia to maintain a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Eating small, frequent meals can help maintain energy levels throughout the day.
   • Hydration: Emphasize the importance of staying hydrated by drinking plenty of water.
7. Professional Help:
   • Therapy: If needed, recommend seeing a mental health professional for therapy to address underlying issues such as depression or anxiety.
   • Medication: If her symptoms are severe and not responding to behavioral strategies, discuss the possibility of medication with a healthcare provider.

CBT-I techniques

1. Sleep Restriction Therapy

• Purpose: To consolidate sleep by limiting the amount of time spent in bed to the actual amount of sleep achieved.
• Technique: Sofia would be instructed to limit her time in bed to the average amount of sleep she gets each night (e.g., if she only sleeps 5 hours, she should stay in bed for just 5 hours). Over time, this period is gradually increased as her sleep efficiency improves.

2. Stimulus Control Instructions

• Purpose: To create a strong association between the bed and sleep.
• Technique:
  • Go to bed only when sleepy.
  • Use the bed only for sleep and intimacy.
  • Get out of bed if unable to sleep within 20 minutes and engage in a quiet, relaxing activity until sleepy.
  • Wake up at the same time every day, regardless of sleep duration.
  • Avoid naps during the day.

3. Cognitive Restructuring

• Purpose: To address and change negative thoughts and beliefs about sleep that contribute to insomnia.
• Technique:
  • Identify and challenge irrational thoughts (e.g., “I’ll never be able to function if I don’t get 8 hours of sleep”).
  • Replace negative thoughts with more balanced, realistic ones (e.g., “I can still function well even if I get less sleep occasionally”).
  • Use a sleep diary to track thoughts and challenge them with evidence-based responses.

Example of a CBT-I Session

1. Assessment and Sleep Diary Review:
   • Review Sofia’s sleep diary to understand her sleep patterns and identify problematic thoughts and behaviors.
2. Setting Goals:
   • Set specific, realistic goals for sleep improvement (e.g., increase total sleep time by 30 minutes within two weeks).
3. Implementing Techniques:
   • Introduce sleep restriction therapy by calculating Sofia’s average sleep time and setting a corresponding time-in-bed schedule.
   • Discuss stimulus control instructions and agree on which steps Sofia will implement immediately.
   • Conduct a cognitive restructuring session, identifying and challenging a specific negative thought Sofia has about sleep.
   • Teach a relaxation technique, such as progressive muscle relaxation, and practice it during the session.
4. Homework Assignments:
   • Sofia would be asked to continue keeping a sleep diary, implement the agreed-upon sleep schedule, practice the relaxation technique nightly, and record any thoughts or worries about sleep.
5. Follow-Up:
   • In subsequent sessions, review progress, adjust strategies as needed, and introduce additional techniques.