Mental Health Book

Sleep Disorders

  • Sleep Hygiene

http://www.fpnotebook.com/

Sleep HygieneAka: Insomnia Nonpharmacologic Management

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  1. Indications
    1. Insomnia
  2. General
    1. Allow 2-4 weeks to see results
  3. Establish a regular sleep schedule
    1. Go to bed at same time each night
    2. Get up at same time each day
    3. Avoid "sleeping-in" on Sunday morning
  4. Cut down time in bed (if not asleep, get up)
    1. Avoid trying to force yourself to sleep
    2. Use your bed only for sleep and sex
    3. Do not read or watch Television in bed
  5. Make the bedroom comfortable
    1. Keep temperature in your bedroom comfortable
    2. Keep bedroom quiet when sleeping
      1. Consider ear plugs (silicon)
    3. Keep bedroom dark enough
      1. Use dark blinds or wear an eye mask if needed
  6. Relax at bedtime
    1. Relax each muscle group individually
      1. Begin with your feet
      2. Work toward your head
    2. Deal with your worries before bedtime
      1. Set aside a worry time for 30 minutes earlier
    3. Listen to relaxation tapes
      1. Classical Music or Nature sounds
    4. Imagine a tranquil scene (e.g. waterfall or beach)
    5. Back Massage
      1. Gentle 5-minute back rub prior to bedtime
  7. Perform measures to make you tired at bedtime
    1. Get regular Exercise each day (6 hours before bed)
      1. Regular Exercise improves sleep
        1. Effect may be delayed 2 months
        2. King (1997) JAMA 277:32
      2. Tai Chi improved sleep in older adults
        1. Li F (2004) J Am Geriatr Soc 52:892
    2. Take medications only as directed
    3. Eat a light bedtime snack or warm drink
      1. Warm milk
      2. Warm herbal tea (non-caffeinated)
  8. Special Therapy Measures
    1. Sleep Restriction Therapy
      1. Limit time in bed for 15 minutes more than sleep
      2. Do not set limit under 4 hours
      3. Increase time by 15 minutes per effective sleep trial
        1. Effective sleep suggests >90% of bedtime asleep
    2. Stimulus Control
      1. Do not lie awake for more than 30 minutes
        1. Get out of bed and perform a quiet activity
        2. Return to bed when sleepy
      2. Repeat as many times per night as needed
      3. No Napping during day
  9. Things to avoid
    1. Do not Exercise just before bedtime
    2. No overstimulating activities just before bed
      1. No competitive games before bedtime
      2. No exciting Television programs before bedtime
    3. Avoid caffeine after lunchtime
      1. Avoid chocolate
      2. Avoid coffee, tea, or soda
    4. Do not use Alcohol to induce sleep (worsens Insomnia)
    5. Do not take someone else's sleeping pills
    6. Do not look at the clock when awakening
    7. Do not turn on light when getting up to use bathroom

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