Information about cognitive behavioral therapy (CBT).
Ann Berger, PhD, RN, of the University of Nebraska Medical Center College of Nursing, says that each person facing sleep disturbances is unique, but research on the effectiveness of cognitive behavioral therapy (CBT) has prompted its addition to the “likely to be effective” category for the Oncology Nursing Society’s Putting Evidence into Practice (PEP) card, which is used by oncology nurses to counsel their patients on numerous issues.
Below are recommendations as they appear on the PEP card, with Berger’s explanation.
PEP card: Go to bed only when sleepy and at approximately the same time every night.
Berger: Sleep restriction is hard, but it’s important to select a bedtime and a wake time for a week and stick to it. No one is perfect, but if you say you are going to bed within 15 minutes of 10:30 every night, that means sometime between 10:15 and 10:45. Our body is wonderful, and the sleep chemicals come out about an hour before you go to sleep. Over time, the body begins waking up when you want to—and the body needs seven to nine hours a night.
PEP card: Get out of bed and go to another room whenever unable to fall asleep; return to bed only when sleepy again.
Berger: Don’t make your bed the enemy. Go to bed with the intention of going to sleep. Turn the lights out, and if in 20 or 30 minutes you are not asleep, go to a preselected place and relax. Read a book with a small light. Nothing stimulating. No TV or computer. When you go back to bed, you will go to sleep. Don’t toss or turn, because then you wake up and say you had a terrible night and that you can’t sleep, which starts negative conditioning.
PEP card: Use the bedroom for sleep and sex only.
Berger: The bedroom should not become the family room. All the things that stimulate should be moved out. Set the environment so the room is cool, dark, and quiet. Your bedroom clothing and covers should be light.
PEP card: Maintain a regular rising time each day.
Berger: This is the hard part, especially when you have to get up early even though it’s the weekend. Sleep researchers say the body gets in the habit of “gentlemen, start your engines.”
PEP card: Avoid daytime napping. If needed, limit to 30 minutes. Do not “catch up” on sleep by going to bed earlier or napping.
Berger: Naps should only be taken at least four hours before bedtime. Try to be active. When people are more active, they have less fatigue and are able to fall asleep better at night.
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The PEP card also includes sleep hygiene techniques to promote a good night’s sleep and optimal functioning. Some of the tips include:
Create a bedtime routine. Start winding down one to two hours before bedtime. Use a preferred relaxation technique, such as taking a warm bath or shower, reading, listening to soft music, or receiving a massage.
Avoid nicotine, caffeine after noon, and alcohol prior to bedtime. Complete dinner three hours before bedtime, and do not go to bed hungry.
Create a comfortable sleep environment. Replace the mattress every 10 to 12 years and pillows more frequently; keep the bedroom dark and cool and use light covers; do not watch TV in the bedroom.
Ensure adequate exposure to bright natural light—preferably in the morning.