Sleep & Relaxation
Sleep & Relaxation Session 1 Understanding Insomnia Sleep improvement techniques Try a new technique Session 2 Dealing with unhelpful thoughts Putting these techniques together for better sleep Relaxation Exercise
Session One : Understanding Insomnia
Introductions and Ground Rules Introductions Invite everyone to introduce themselves Facilitator introduces themselves and the group s purpose, i.e. to discuss techniques that will help people to get a good night s sleep. Note that tea, coffee and biscuits will be provided Group rules Ask the group what ground rules they would like. Facilitator would suggest - Talking one at a time - Respecting each others opinions and points of view - No sleeping in the group! - Switch off mobile phones - Try to stay for entire 30 minutes if possible - Everyone try to get involved
What is Insomnia? Most people will experience insomnia the inability to sleep at some point during their lives. Insomnia is a very common problem which over one third of the adult population experiences from time to time.
Question to the group: How many hours sleep do we need a night?
How many hours sleep do we need? Varies from person to person People with sleep problems tend to over-estimate the amount they need. Sleeping badly the night before doesn t necessarily mean people perform worse the next day, e.g. on reasoning skills, problem solving abilities. However, it can make people more irritable, less patient and bad tempered.
Question to the group: How common is insomnia?
How common is insomnia? Office for National Statistics, 2001
What is insomnia? Insomnia is the inability to get high-quality sleep. It can last a day or two, a month, or even months on end. Because different people need different amounts of sleep, insomnia is not defined by the number of hours you sleep or by how quickly you fall asleep. Instead, it depends on the quality of your sleep, and how you feel after sleeping. Even if you are sleeping eight hours a night, if it is poor quality sleep and you re still feeling drowsy and fatigued during the day, you may be experiencing insomnia.
Symptoms of Insomnia at Night Time Difficulty falling asleep despite being tired Using alcohol to fall asleep Awakening frequently or lying awake in the middle of the night Awakening too early in the morning and not feeling refreshed
Symptoms of Insomnia in the Day Time Daytime drowsiness, fatigue, or irritability Weakened immune system Increased risk of depression, anxiety and substance abuse
What Causes Insomnia? There are some causes you might be able to influence while on the ward: Anxiety! This is covered in session 2 Diet: food, alcohol and supplements - Caffeine and nicotine (cause restlessness and delay sleep), alcohol (depressant; encourages light sleep but inhibits deep sleep). A lot of people use alcohol to get to sleep, but in fact alcohol causes unconsciousness (which is not the same as sleep). Poor sleep hygiene - Shift work, naps, exercise or mentally intense activities before bedtime, eating too close to bedtime
What Causes What Insomnia? is CBT? and some causes you might not be able to influence while on the ward: Sleep environment - Noise, light, room temperature, comfort and size of bed, disruptive sleep partner or family members. This is something you can think about when you return home. Medical and physical obstacles - Illnesses, pain, depression, anxiety, other illnesses. So because you can t so much about these things, you ll need to focus on the causes you can influence.
Strategies for improving sleep You might not think you need to do these things If you don t have sleep problems, then you re probably right These are all things supported by the research as things that can help with insomnia Some of them may be things that are difficult to do. It is not always easy to put these strategies in place
Background: Cognition Getting up and going to bed at a set time
Use the bed only for sleeping
Get out of bed when you can t sleep
Don t worry, plan or problem solve in bed
Avoid day time napping
Avoid excessive time in bed
Limit caffeine intake
Limit alcohol
Take regular exercise (but not too close to bedtime!)
Try a light bedtime snack (such as banana, camomile tea or hot milk)
Summary Set a standard rising time Use the bed only for sleeping Get out of bed when you can t sleep Don t worry, plan or problem solve in bed Avoid daytime napping Avoid excessive time in bed Determine the amount of time you ll spend in bed Limit caffeine and alcohol Exercise regularly Try a light snack before bed
Try a new strategy Pick one of the strategies we have just discussed which you are not currently using. Write it down on your piece of card. Try this out and let us know how you get on next week. Remember none of these strategies will be a complete solution, but should be things that will help a bit
Conclusion Thank everyone for coming The next group is in at
Session 2: Coping with unhelpful thoughts Setting the scene Facilitator introduces the group s purpose, i.e. To discuss techniques that will help people to get a good night s sleep. Note that tea, coffee and biscuits will be provided Recap the group rules from session 1 - Talking one at a time - Respecting each others opinions and points of view - No sleeping in the group! - Switch off mobile phones - Try to stay for entire 30 minutes if possible - Everyone try to get involved
Review sleep tips from session 1 Set a standard rising time Use the bed only for sleeping Get out of bed when you can t sleep Don t worry, plan or problem solve in bed Avoid daytime napping Avoid excessive time in bed Define in advance the amount of time you ll spend in bed Limit caffeine and alcohol Exercise regularly Try a light snack before bed How did people get on trying a new strategy? If they didn t manage to do it, what were the obstacles?
Insomnia and the brain Research shows that there is a particular way of thinking associated with sleep Tends to be very focused on the effects of not sleeping Lots of worrying, negative thoughts It s a habit, but habits can be broken Try leaving the bedroom first, but if the worrying thoughts keep occurring, try these techniques.
What is worry? Worry can be a problem solving strategy, with an emotional component. It is not necessarily a bad thing: it can help us solve problems, it shows you are conscientious because you care about things. We all worry at times, it is unavoidable. Worry becomes a problem when it starts to interfere negatively in your life, e.g. by stopping you getting to sleep.
Constructive worry This is a strategy for coping with worry: Try this exercise 3 hours before bedtime. Write down the problem that has the greatest chance of concerning you once you go to bed. Clearly identify the problem. Brain-storm all the possible solutions. If you had a friend who had this worry, how would you advise them? Evaluate the possible solutions. Try to pick the best solution(s). It might be that no solution is ideal, in which case just got with the one that seems best. If the problem doesn t have a solution, and for now you are just going to have to live with it, write that down. Repeat this for other concerns you might have.
Constructive worry Discuss what you have written down with someone else, for example, with your nurse during 1-to-1 time, or anyone else you are close to. Don t expect them to come up with a solution to the worry. The idea is that a problem shared is a problem halved, not that they will necessarily be able to come up with the solution for you.
Ruminating in bed I don t worry about things at all during the day, but as soon as my head hits the pillow Does this experience sound familiar? Try to set aside some time every day for worrying. This is your worry time! If you notice that you are worrying about things at other times, just remind yourself to set that worry aside until later. Your worry time can be quite long if necessary, e.g. 2 hours or more, but you should try to gradually reduce it. Crucially, your worry time should be early on in the day, not just before you go to bed!
Review sleep tips from session 1 Worry can often stop is getting to sleep. This can then lead to worry about not being able to get to sleep, which in turn stops us sleeping. It become a vicious circle! We covered 2 strategies for coping with worry: (i) (ii) Write down your worry. Try to come up with solutions. Talk this through with someone else. Set aside a specific time during the day for worry not just before bed time. There is one more strategy
Relaxation session You can give patients a taped copy of relaxation exercise Encourage people to listen to this tape in the evening, if you are having difficulty getting to sleep. If not possible, just try to think back to the feeling of relaxation you had while listening to the tape. Remember, like everything else, relaxation is a skill which takes practice.