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Sleep education: normal sleep




Sleep education is the most fundamental aspect of managing sleeping difficulties. Education is necessary to encourage substantial and sustained behavioural change. The patient needs to understand the rationale for the changes required to improve their sleep quality in order to be motivated and also to accept personal responsibility for initiating them.

The right amount of sleep one needs in order to feel awake, refreshed and function throughout the day may vary with age, gender as well as mental, health and physiological status. Sleep education is the foundation for teaching patients how to improve their sleep and also helps reshape their expectation of normal sleep and therefore serves as the foundation for successful treatment of insomnia. This is because patients’ expectations and what they consider to be normal sleep may be inaccurate and based on misinformation from others. This presents the opportunity for practitioners to provide the patient with reliable and useful information on sleep.

Basic sleep knowledge includes;

Sleep pattern and duration varies from person to person and from night to night.

Sleep latency of less than 30 minutes and total wakefulness during the night of less than 30 minutes is within normal limits.

Incorrect beliefs and expectations can increase concern about sleep and cause further difficulty with sleep.

Sleep is regulated by an ‘internal body clock’ that is sensitive to light, time of day and other relevant cues for sleeping and awakening. There are four stages of sleep and these stages are important for overall sleep quality.

Stage 1

This is the drowsiness stage and it occurs during the first 5 to 10 minutes of falling asleep. During this stage the eyes move slowly under the eyelids, muscles activities slow down and one can easily be awakened.

Stage 2

It is the light sleep stage during which eye movements stop, heart rate is slow and body temperature decreases.

Stage 3 and 4

This is known as the deep sleep stage where it is difficult to be awakened or even if one is awake will feel disoriented for several minutes. During this stage blood flow to the brain decreases and redirects itself to the muscles, restoring physical energy.

Cognitive elements of sleep are activities associated with thinking that disrupts sleep and replacing them with more adequate ones. This consists primarily of sleep education, keeping patients expectations realistic and examination of internal and external causes as well as the consequences of sleep disturbances.

Sleep education: normal sleep

Keep expectations realistic

Examine causes: internal vs. external

Don’t blame all daytime problems on sleep

Don’t catastrophise

Don’t give sleep too much importance

Develop tolerance to effects of sleep loss

Never try to sleep

The patient tends to focus on their sleep difficulty which leads to a vicious cycle increasing arousal at bedtime and therefore increases the severity of sleep disturbance. The may complain that they are “unable to shut off my mind”. ‘Trying to sleep’ may actually increase anxiety and make the problem even worse. Cognitive elements of insomnia, if left untreated, could lead to persistence of the problem.

Cognitive treatment is aimed at addressing cognitive changes that accompany sleep disturbances and eventually contribute to the problem. These include irrational fears (I can’t function normally if I don’t get more sleep), unrealistic expectations (I need more than 8 hours of sleep to be able to function) and excessive worrying about sleep (I wonder if I will be able to sleep tonight which put additional pressure on the sufferer leading to stress, arousal and further sleep disturbance. Cognitive therapy challenges these beliefs and fears and provides the sufferer with other approaches to viewing sleep. This can be accomplished by first identifying the cognitive problems then challenging (cognitive reconstruction) and replacing them with more rational interpretation of the situation.

Stay awake in bed but relaxed

Cognitive control: to do list

Thought blocking: “the, the…”

Simple cognitive techniques can help those who have difficulty falling asleep.

Staying awake in bed but remaining relaxed can be helpful.

Writing down a ‘to do’ list of tasks and concerns for the following day can help.

If thoughts are racing through a patients head these can often be effectively blocked by repeating a nondescript word such as ‘the’ in ones mind.