but welcome to another MedCram lecture where we were talking about before was
the general approach to somebody with insomnia so we've said that the general
approach was to look for diseases that could cause it and if that didn't
elucidate exactly what the cause was then look for other things specifically
sleep hygiene stimulus control which we're now going to talk about and then
move on to behavioral therapy and medication we had said in the last
lecture that medications actually a lot lower down on the list then one might
think so in this section let's talk about what sleep hygiene is and stimulus
control so here I've got listed the category of sleep hygiene and stimulus
control and specifically the different components of what sleep hygiene and
stimulus control are there are actually different so let's take these one step
at a time first of all sleep hygiene specifically
is making sure that you are performing and doing the right things when you go
to bed so that we don't perpetuate and that goes back to the lecture of just
before so that we don't perpetuate some bad habits that could keep you up at
night so the first thing is to sleep until rested and then get up the key
there is to get up we do not want you to stay in bed after your Vokoun up some
people wake up early and they stay in bed for another hour or so this is not a
good thing because again what we're doing is we're associating the bedroom
with you being awake and we don't want that we want you to associate sleeping
with the bedroom so sleep until rest it and then get up get out of bed and do
your activity you also want to keep a regular sleep schedule and this is to
make sure that your circadian rhythm is in tune and it's gonna be much easier if
when it's time to go to bed you are actually are going to bed so keeping a
regular sleep schedule would be important this can be broken with people
who do for instance graveyard shifts or nocturnal shifts so that can be a
problem number three is do not force leave so there's nothing worse than
trying to go to sleep when your body doesn't want to go to sleep and then
when it doesn't go to sleep you become anxious and then you associate anxiety
with the bedroom and you get performance anxiety remember we called that
psychophysiological insomnia we don't want that next number is to exercise
regularly but make sure you don't do it right before you go to bed make sure
it's at least four to five hours before you go to bed because while exercise is
good it can also limit your ability to go to sleep right afterwards
number five is pretty obvious avoiding caffeinated drinks in the afternoon or
evening this is gonna ramp you up and it's gonna make it more difficult for
you to go to bed in a similar token avoiding alcohol at bedtime now this may
seem counterintuitive because alcohol is a central nervous system depressant
however the thing that you have to realize is that yes it may help someone
go to sleep initially but because it is so short acting you're gonna get a
rebound awakening maybe two three four hours later and so you might find it in
the middle of the night waking up because of alcohol you want to avoid
smoking in the p.m. I would say avoid smoking altogether this is for many
different reasons of course but smoking causes edema of the airway can
exacerbate obstructive sleep apnea among other things don't go to bed hungry
again we want to be satisfied when we go to bed it's much easier to fall asleep
you want to adjust your bedroom environment so make sure the room is a
little bit cooler make sure that there is no light coming in make sure that
your soundproofed just take care of the obvious things that would prevent you
from going to sleep if you sleep with a dog or a baby these things may kick you
and may wake you up without you even knowing it so just be sure that that is
taken care of and then finally deal with your worries before bedtime so I would
advise avoiding television or the news things that are usually bad news if
you've got worries on your mind you may want to write those things down on a pad
and put it at your bedside and say I'm gonna deal with those things in the
morning okay so sleep hygiene is one of the first things that we do and somebody
who just can't sleep and to make sure that we're avoiding some of
these perpetuating factors that could prevent them from going back to a
regular sleep schedule stimulus control is a little bit different now
now stimulus control has to do with classical conditioning
you remember Pavlov's dogs Pavlov's dogs were these creatures that Pavlov the
scientists kept and he noticed that before feeding them if you rang a bell
eventually got to the point where all he had to do was ring the bell and they
would salivate instead of when he put the food in front of them
they would start to salivate and the reason is this because the brains of the
dogs associated the bell with dinnertime and in this situation with sleep we want
to associate correct things with the bedroom we don't want to associate non
sleep activity with the bedroom because if we do that it's going to dilute that
stimulus control to cause us to go to sleep so just like on sleep I dream we
said sleep until rested and then get up congruently we want to only go to bed
when sleepy so if we go to bed when we're not sleepy we're not going to
sleep and then we associate not being able to go to sleep and the anxiety
associated with that with the bedroom so what I'm saying here is that if you go
to the bedroom and you can't sleep and get out of bed and go to another room in
the house so the other one is to use the bedroom for sleep and sex only so no
television no reading no eating no no other activity in the bedroom we don't
want to dilute the stimulus of the bedroom okay number three is get out of
bed if not able to sleep in 20 minutes this kind of goes along with number one
so you would only return to the bed when you were sleepy and you'd need to repeat
this as many times as necessary throughout the night this is to ensure
that you're only associating sleep with the bedroom number four is wake up at
the same time each day use an alarm clock if necessary again this is kind of
congruent with keeping a regular sleep schedule and then finally no napping
napping in the afternoon is going to rejuvenate you and it's going to reduce
your homeostatic drive to sleep when you get to nighttime so again this is sleep
hygiene stimulus control these are the top so
of things that we do for a an insomnia patient on the initial intake after
we've ruled out some obvious diseases that could cause the insomnia and again
if you look at our approach for insomnia the general approaches we're going to
look for diseases we're going to do hygiene and stimulus if that doesn't
work and your patient still has insomnia then we would move on to the next step
which is behavioral therapy and medication join us for the next lecture
where we talk about behavioral therapy thanks for joining us
you