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On the last track we discussed behavioral sleep therapy for children. For the purpose of this course, one method of behavioral sleep therapy for children will be explained in two parts. Behavioral sleep therapy for children consists of initial progression and subsequent progression.
On this track and the next track we will discuss behavioral interventions for insomnia. As you know, insomnia can be a common sleep disorder among clients. Four behavioral interventions for insomnia that we will discuss are stimulus control therapy, sleep restriction therapy, relaxation therapies, and cognitive therapy. The focus of this track will be on the first two interventions, stimulus control therapy and sleep restriction therapy. As you listen to this track, consider your client who has insomnia. Which behavioral intervention might benefit your client?
Intervention #1: Stimulus Control Therapy
Stimulus control therapy was developed by Dr. Richard Bootzin as a way to test his theory that reducing time awake in bed could reduce a subconscious association that he believed may cause insomnia in some clients. For example, if a client spends time awake in bed often enough, that client will begin to associate their bed with wakefulness. Such was the case with Garrett.
Garrett's 6-Step Stimulus Control Therapy
Intervention #2: Sleep Restriction Therapy
The first step in sleep restriction therapy for Julie was to keep a sleep log for seven to ten days. Julie calculated her average time in bed and the average time she spent sleeping. You might consider suggesting to your client that he or she also list the date, bedtime, how many times per night he or she wakes up, wake time, and rise time as well.
After ten days of keeping her sleep log, Julie found that on average she was in bed for 9 hours. Of that time, Julie slept for about 6 and a half hours. Clearly Julie was lying awake each night for about three hours. I felt that correcting Julie’s sleep problem could best be done by her going to sleep later in the evening. However, Julie stated, "After 10:30 I really don’t have anything going on so going to sleep later would just be a waste of time. I’d rather get up earlier so I can have more time in the morning."
Julie decided to go to bed at 11 and wake at 6:30, which provided her with seven and a half hours of sleep. Julie was then at the starting gate for the rest of her sleep restriction therapy.
At a later session, Julie stated, "I’m having a hard time getting that 85%. What should I do now?" How would you have responded to Julie? I suggested to Julie that she continue to reduce her time in bed. I stated, "Spend only the amount of time in bed that your sleep log shows that you are sleeping."
For example, Julie mentioned that she was now spending seven and a half hours in bed, but sleeping only six. She cut her time in bed down to six and soon found that she was sleeping for five and a half hours each night. Clients like Julie can continue to reduce sleep time and time in bed until they approach four hours of sleep. As you already know, any less than four hours of sleep is not advisable. How many hours of sleep a night is your client getting? How much of his or her time in bed is spent awake?
On this track we have discussed two behavioral interventions for insomnia. The two behavioral interventions for insomnia that we discussed are stimulus control therapy and sleep restriction therapy.
On the next track we will discuss combined stimulus control therapy and sleep restriction therapy, as well as two additional behavioral interventions for insomnia. The two additional behavioral interventions for insomnia are relaxation therapies and cognitive therapy.
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