I. Review of Homework – Practicing Pacing
II. Sleep Survey
III. Facts About Sleep
IV. Sleep Disorders
V. Treatments
VI. Homework – Practicing Good Sleep Behaviors
VII. Relaxation Technique – Deep Breathing Exercise

1. What time do you usually go to bed and get up on weekdays?

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2. What time do you usually go to bed and get up on weekends?

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3. Do you keep a fairly regular sleep schedule?

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4. If you could set your own schedule, when would you go to bed and when would you get up?

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5. How long does it usually take for you to fall asleep? Do you usually have trouble getting back to sleep?

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6. How often do you wake up during the night? Do you usually have trouble getting back to sleep?

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7. In an average night, how many hours do you actually sleep?

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8. Do you often feel exhausted during the day because of lack of sleep? Does your excessive sleepiness often interfere with your work or social life?

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9. Have you ever had an accident or near-accident because of sleepiness from not being able to sleep the night before?

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10. Do you usually nap during the day? How long, on the average?

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11. Do you do shift work?

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12. Are you often bothered by waking up earlier than you want to and not being able to get back to sleep?

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13. When did your primary difficulty with sleep begin? What was happening in your life at that time?

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14. Are your sheets and blankets in extreme disarray in the morning when you wake up?

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15. Do you awaken yourself by kicking your legs during the night?

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A. About 1/3 of our time is spent asleep.
B. When we get adequate sleep, all is well.
C. When sleep is disturbed: daytime tiredness, sleepiness, inability to concentrate, and irritability.
D. Incidence:

    1. How many of you had a sleep problem last year?
    2. 16 - 40 % of adults in general population report sleep problems.
    3. 15 – 20 % of these will see a doctor for assistance.
    4. Much greater % of individuals with Chronic Pain have problems sleeping.

E. Large variation in need to sleep (2 hours 10 minutes to most people 7 hours 9 minutes). Urging someone to sleep for eight hours is like saying everyone should wear a medium shirt.
F. The need for sleep changes over the course of a person’s life.
Generally, the need decreases, as a person gets older. Newborns = 2/3; Adults = 1/3.
G. By age 60, there is a large increase in wakefulness during the night.
H. When people do go to Doctors for sleep problems, 50% get a pill.
I. Sleeping pills have side effects: psychomotor impairment,

dependency, loose effectiveness over time, difficulty with sleep, and difficulty with withdrawal.

1. Psychophysiological Insomnia - Trouble falling/staying asleep caused by emotional arousal (anxiety, stress) or learned (conditioned) responses (bad habits - such as caffeine before bed).

Recommended Treatment: Education about sleep habits.

2. Affective State Related Insomnia – Difficulty falling/staying asleep because of affective disorders such as depression.

Recommended Treatment: Psychotherapy, medications, activity, pleasure, and education about sleep habits.

3. Drug Related Insomnia - Chronic alcoholism, chronic hypnotic medication use (hypnotics like Valium). Sleep problems also follow withdrawal from alcohol or hypnotic medication use.

Recommended Treatment: Gradual tapering off drugs and avoiding future use. Supportive psychotherapy. Education about sleep habits.

· Prepare a good sleep environment. (Dark room, slightly cool, firm mattress, hide clock).

· Unwind before bed. (Develop a ritual so your body knows sleep is coming).

· Take a warm bath 1 to 2 hours before bedtime. 20 minutes in a relaxing tub raises the body temperature by several degrees, which naturally induces drowsiness and sleep.

· Reduce caffeine, alcohol, or excessive liquid intake.

· Avoid naps during the day.

· Do not go to bed too early and determine how many hours of sleep you need.

· Go to bed only when you are sleepy.

· Engage in physical activity. Physical activity tires your body for sleep. Exercise also decreases body tension, alleviates stress, alleviates depressive symptoms, and contributes to an overall sense of well-being. Remember: Exercise early in the day, exercising right before bed can cause you to be more alert.

· Avoid continual use of medications. When you stop taking drugs, such as, tranquilizers and sleeping pills, it might take a long time for your sleep to return to normal.

· Use the bed only for sleeping or sex; do not read, watch TV, or eat in bed.

· If unable to sleep after 20 minutes, get out of bed, move to another room, and stay awake until sleep, then return to bed. If sleep still does not come, repeat the same steps.

· Set an alarm and get out of bed the same time every morning, regardless of how much or how little sleep has occurred.

· Learn and use relaxation techniques to reduce muscle tension.

· Keep a sleep log.
· Get a handle on daily hassles and seek professional assistance if necessary.

1. Lie down on the floor or sit up straight in your chair. Make sure not to cross your arms or legs.

2. Scan your body for tension.

3. Place one hand on your abdomen and one hand on your chest.

4. Inhale slowly and deeply through your nose. Feel the gentle downward push of the diaphragm. (The diaphragm pushes against the stomach, which lets the area above the naval bulge out.)

5. Exhale slowly and pull stomach muscles towards the spine during the entire exhalation.

6. Inhale, slowly and gently, being conscious of shoulders and chest being perfectly still.

7. Exhale slowly and experience a calm and peaceful feeling.

8. Continue to breathe deeply for the next 4 minutes.

9. Smile slightly and inhale through your nose and exhale through your mouth, making a quiet, relaxing, whooshing sound like the wind as you blow gently out. Your mouth, tongue, and jaw will be relaxed. Take long, slow, deep breaths that raise and lower your abdomen. Focus on the sound and feeling of breathing as you become more and more relaxed.

10. Continue to breathe making the whooshing sound for the next 4 minutes.

11. Once more scan the body for tension. Compare the tension you felt at the beginning to the tension you feel now.

Continue deep breathing for about five or ten minutes at a time, once or twice a day. Then, if you like, gradually extend this period of time twenty minutes.

Davis, M., Robbins Eshelman, E., & McKay, M. (2000). The Relaxation and Stress Reduction Workbook 5th ed. Oakland, CA: New Harbinger Publications, Inc.

Strinivasan, M. (1989). A practice manual of hatha yoga. Baton Rouge, LA:
Author.