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Exercise. Another non-clinical treatment for sleep difficulties is regular exercise. Exercise has been demonstrated to decrease the reporting of sleep difficulties and decrease the amount of time that it takes individuals to fall asleep (Duncan et al., 1995: Matsumoto et al., 1984; Youngstedt et al., 1999), as well as increasing the time spent in stage 3 and 4 sleep (deep sleep) (Dement, 1999). In general, any exercise that is practiced regularly appears to have beneficial effects on sleep; however, a few types of exercise seem to have a greater effect. Exercises that involve a large cardiovascular component have a greater effect than exercises that do not include a cardiovascular component (Trinder et al., 1985). Hence, vigorous stationary cycling would be expected to have greater effect than weightlifting. However, it should be noted that all exercise appears effective in reducing sleep difficulties and time to fall asleep, at least to some extent. Based on this, it behooves interventionists who are working with individuals suffering from sleep difficulties to encourage their clients to develop regular exercise schedules since it will not only improve their general health, but also reduce attendant sleep difficulties.
Bright Light Therapy. Another suggested non-clinical treatment is bright light therapy. Bright light therapy has been demonstrated to be an effective treatment for disturbed sleep schedules, especially for individuals who have shifted their sleep and wake times out of phase with the norm (Campbell and Murphy, 1998; Rosenthal et al., 1990). While many studies use between 1000 to 10,000 lumens, artificial light as low as 250 lumens has been found to significantly impact circadian sleep rhythms (Trinder et al., 1996). The application of bright light therapy is actually easy, very affordable and is very conducive to the treatment of early morning or late night insomnia. To conduct bright light therapy only one piece of equipment is needed, a bright light that emits a broad light spectrum (a 500-Watt Halogen lamp is usually sufficient). The individual is instructed to place the light in a position where they can get full exposure to the light while they are doing their normal activities of the day. For most individuals, exposure to the light should last for 30–60 minutes and the timing during the day will depend on the particular phase syndrome the individual is suffering from. The exposure to the bright light will enable the person's circadian rhythm to begin to shift into a more normal mode. Continued repetition of this procedure over time will help shift the circadian rhythm to match the day and night cycles that are natural in the environment. Once the circadian rhythm is in line with the natural cycles the individuals should begin experiencing more normal sleep schedule and have fewer difficulties with sleep. In summary, bright light therapy is simple to use and affordable. With minimal instruction individuals can conduct bright light therapy at their residences immediately.
Relaxation. Relaxation therapies focus on decreasing arousal level to ease sleep onset. Specifics include behavioral relaxation therapy such as progressive muscle relaxation and deep breathing, as well as cognitive imagery. The latter may entail imagining oneself on a beach or other pleasant place like lying in the sun, if a positive situation for the client. Imagining a feeling of warmth also helps. Behavioral approaches tend to work well with simple physical restlessness, while imagery is effective for people who have both mental and physical restlessness, such as ruminating about the day's events (Morin and Wooten, 1996). For all relaxation approaches it is beneficial for the therapist or counselor to first instruct the client how to relax using the chosen technique in session. Homework geared toward between-session practice with a review at the next session for fine-tuning and feedback can facilitate effectiveness. In each instance close monitoring on the part of the therapist tends to increase compliance and effectiveness of relaxation techniques. Counselors are encouraged to help clients create their own relaxation tapes. Making a tape encourages individuals to import their interests and ideas into their treatment. For deep muscle relaxation audio-taping the client session exercise and giving the tape to the client for home practice can be beneficial. Listening to a tape when attempting to fall asleep takes less cognitive effort than trying to remember the steps to relaxation taught by a therapist. Further, expecting those with sleep difficulties to spend hours in therapy learning relaxation techniques may simply create a situation for non-compliance, whereas creating a relaxation tape enables them to continue treatment with less professional monitoring. No matter what approach to relaxation that is used by the therapist and client, it is important that the individual consistently apply the approach on a regular basis. Without consistent applications, effectiveness of relaxation techniques to reduce sleep difficulties diminishes.
Cognitive Therapy. Cognitive therapy often focuses on patients' expectations. Often a key component is to help clients change their views from believing they are out of control and are victims to thinking they are capable of coping with situations. Refuting irrational beliefs and thought stopping have been demonstrated to be effective in treating sleep difficulties (Bootzin and Perlis, 1992). Frequently, small successes experiencing control facilitates further expectations of success. For example, if the client can learn to control bedtime and related circumstances with the help of the therapist, two expectations are encouraged. The therapist is validated as a legitimate source of help and, once small successes are experienced with the help of the therapist, larger ones become a logical progression and are anticipated. Another final method of changing the way in which clients view their sleep difficulties is paradoxical intent (Bootzin and Perlis, 1992). Paradoxical intent consists of instructing clients to do the opposite of what they have been doing. Many clients try very hard to fall asleep and can become anxious about it, especially those for whom sleep concerns are sufficient to seek professional help. As a result, clients' sleep becomes more difficult and quality worse. For example, a paradoxical prescription may be to ask the person to attempt to wake up at least 3 times throughout the night for the next 7 nights. Success indicates the person does have control over his or her sleep, while ‘failure’ would mean the person woke less than 3 times during the night—a significant improvement for some clients. While this treatment may sound counterintuitive, a meta-analysis of over 100 sleep treatment studies found that paradoxical intent is slightly more effective than most psychological interventions for reducing unwanted night time awakenings, but less effective in reducing sleep-onset time (Murtagh and Greenwood, 1995).
Reflection Exercise #6
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