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.Strategies to cue waking up can complete an interventionas sometimes the individual may be anxious about going to sleep in case they donot wake up on time.Table 12.4 provides a selection of behavioural strategies whichmay be tried at appropriate times.The Companion Website includes a version of thestrategies which clients may find helpful.In order to improve the sleep of Jane, the mature student (described in Table 12.3), thetherapist suggested avoiding all sleeping during the day.She also developed a routinewhereby she did not drink any tea or coffee after 4 pm, she ate her evening meal at7 pm and did not drink any alcohol during the week.At 11 pm, she changed into hernightclothes, brushed her teeth then sat for 30 minutes in the living room listeningto relaxing music and reading a magazine.Then she went to bed at 11.30 pm.For the 228 ADHD IN ADULTSTable 12.4 Behavioural sleep strategiesDuring the dayAvoid taking naps and do not lie downWhen the client is feeling tired, it can be tempting for them to cat nap.Whilst this is aquick fix with a short-term gain (and therefore appealing to individuals with ADHD), it islikely to disrupt sleep in the night.If the client feels particularly tired during the day, theymay take rests without lying down, or alternatively try to distract themselves by becominginvolved in a more energising taskRelax by reading/listening to music if necessaryInstead of sleeping during the day, the client should be encouraged to read or listen tomusic (but not in the bedroom).If they perform these activities when feeling tired, theymay become conditionally paired with this feeling, and thus induce this state in the eveningwhen the individual needs to sleepMake a list of the activities for the following dayThis prevents mental rehearsal at night when the client is attempting to get to sleep buttrying not to forget certain things they need to do the next dayEating and drinkingThe client should avoid heavy meals just before going to bed as this can cause increasedalertness.Spicy and acidic foods may cause indigestion, which will affect sleep.However,light snacks that are high in carbohydrates but low in sugar can be helpful before going tobed.Also, drinking too much liquid in the few hours before bed may mean that sleep isdisturbed by a need to go the toilet in the night, so clients should limit their liquid intake inthe later part of the eveningSmokingNicotine is a stimulant, which acts in a similar way to caffeine and stimulant medication,and therefore should be avoided just before bedtime.Smokers may therefore have reducedREM sleep and only sleep very lightly.Some heavy smokers may wake up a few hours aftergoing to sleep due to nicotine withdrawal.It is advisable for people to avoid smoking if theywake up in the nightAlcoholThe effects of alcohol on sleep are counterintuitive.Although alcohol can make drinkersfeel drowsy, it actually prevents people from achieving REM and deeper sleep.Alcoholinduces only a light sleep and therefore the restorative processes cannot occur, andindividuals may be woken up more easily.Alcohol consumption should be avoided or keptto a minimum when treating a sleep disorderBefore sleepMaintain a consistent bedtimeIrregularities in bedtimes for people with ADHD are often determined by what ishappening around them.For example, starting to watch a film late at night, being invitedto go for late-night drinks.This should be minimised where possible during the sleepintervention as having a consistent bedtime allows a routine to develop where sleep isexpected at a certain timeChanging bedtime to when normally get to sleep.For example, if a client is only getting four hours of sleep per night, then they should only beallowed four hours in bed but this can be gradually increased by 15 30 minutes per night SLEEP PROBLEMS 229Table 12.4 (continued)Follow a routineAn hour or more before going to bed, the client should allow a winding down period,which can be organised into a routine.For example, reading enjoyable magazines or books,listening to music, having a bathGet ready for bedThis should be done before the client gets tired or commences the winding down routine inorder to avoid waking themselves up by the routine.For example, brushing teeth and washingor showering can wake up the individual as these activities are also associated with the morningOnly get into bed when tiredThe aim is to associate the bedroom with rapid onset of sleepIn bedAvoid activities incompatible with sleepingFor example, watching TV or listening to the radio, eating, reading in bed should all beavoided.The bed must be associated with sleep and intimacy, and nothing elseDo not lie awake for long periodsIf the client is unable to fall asleep within 30 minutes, they should get out of bed, move toanother room and only return to bed when they are ready to fall asleep.They should makesure the room is not at a noticeably different temperature from that of the bedroom.If theyreturn to bed and still cannot sleep, this stage should be repeated.The goal is to minimisethe amount of time spent in bed ruminating about lack of sleepAwakeningRegular alarmThe client should be encouraged to try and wake with an alarm and rise at the same timeeach day, even at weekendsTwo alarm clocksIt may be helpful to set two alarm clocks.The client can take their medication when woken bythe first clock in order to improve their concentration and focus for their morning routine.Theclient should also set a second alarm clock at a time when their medication is likely to have begunacting [ Pobierz całość w formacie PDF ]
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.Strategies to cue waking up can complete an interventionas sometimes the individual may be anxious about going to sleep in case they donot wake up on time.Table 12.4 provides a selection of behavioural strategies whichmay be tried at appropriate times.The Companion Website includes a version of thestrategies which clients may find helpful.In order to improve the sleep of Jane, the mature student (described in Table 12.3), thetherapist suggested avoiding all sleeping during the day.She also developed a routinewhereby she did not drink any tea or coffee after 4 pm, she ate her evening meal at7 pm and did not drink any alcohol during the week.At 11 pm, she changed into hernightclothes, brushed her teeth then sat for 30 minutes in the living room listeningto relaxing music and reading a magazine.Then she went to bed at 11.30 pm.For the 228 ADHD IN ADULTSTable 12.4 Behavioural sleep strategiesDuring the dayAvoid taking naps and do not lie downWhen the client is feeling tired, it can be tempting for them to cat nap.Whilst this is aquick fix with a short-term gain (and therefore appealing to individuals with ADHD), it islikely to disrupt sleep in the night.If the client feels particularly tired during the day, theymay take rests without lying down, or alternatively try to distract themselves by becominginvolved in a more energising taskRelax by reading/listening to music if necessaryInstead of sleeping during the day, the client should be encouraged to read or listen tomusic (but not in the bedroom).If they perform these activities when feeling tired, theymay become conditionally paired with this feeling, and thus induce this state in the eveningwhen the individual needs to sleepMake a list of the activities for the following dayThis prevents mental rehearsal at night when the client is attempting to get to sleep buttrying not to forget certain things they need to do the next dayEating and drinkingThe client should avoid heavy meals just before going to bed as this can cause increasedalertness.Spicy and acidic foods may cause indigestion, which will affect sleep.However,light snacks that are high in carbohydrates but low in sugar can be helpful before going tobed.Also, drinking too much liquid in the few hours before bed may mean that sleep isdisturbed by a need to go the toilet in the night, so clients should limit their liquid intake inthe later part of the eveningSmokingNicotine is a stimulant, which acts in a similar way to caffeine and stimulant medication,and therefore should be avoided just before bedtime.Smokers may therefore have reducedREM sleep and only sleep very lightly.Some heavy smokers may wake up a few hours aftergoing to sleep due to nicotine withdrawal.It is advisable for people to avoid smoking if theywake up in the nightAlcoholThe effects of alcohol on sleep are counterintuitive.Although alcohol can make drinkersfeel drowsy, it actually prevents people from achieving REM and deeper sleep.Alcoholinduces only a light sleep and therefore the restorative processes cannot occur, andindividuals may be woken up more easily.Alcohol consumption should be avoided or keptto a minimum when treating a sleep disorderBefore sleepMaintain a consistent bedtimeIrregularities in bedtimes for people with ADHD are often determined by what ishappening around them.For example, starting to watch a film late at night, being invitedto go for late-night drinks.This should be minimised where possible during the sleepintervention as having a consistent bedtime allows a routine to develop where sleep isexpected at a certain timeChanging bedtime to when normally get to sleep.For example, if a client is only getting four hours of sleep per night, then they should only beallowed four hours in bed but this can be gradually increased by 15 30 minutes per night SLEEP PROBLEMS 229Table 12.4 (continued)Follow a routineAn hour or more before going to bed, the client should allow a winding down period,which can be organised into a routine.For example, reading enjoyable magazines or books,listening to music, having a bathGet ready for bedThis should be done before the client gets tired or commences the winding down routine inorder to avoid waking themselves up by the routine.For example, brushing teeth and washingor showering can wake up the individual as these activities are also associated with the morningOnly get into bed when tiredThe aim is to associate the bedroom with rapid onset of sleepIn bedAvoid activities incompatible with sleepingFor example, watching TV or listening to the radio, eating, reading in bed should all beavoided.The bed must be associated with sleep and intimacy, and nothing elseDo not lie awake for long periodsIf the client is unable to fall asleep within 30 minutes, they should get out of bed, move toanother room and only return to bed when they are ready to fall asleep.They should makesure the room is not at a noticeably different temperature from that of the bedroom.If theyreturn to bed and still cannot sleep, this stage should be repeated.The goal is to minimisethe amount of time spent in bed ruminating about lack of sleepAwakeningRegular alarmThe client should be encouraged to try and wake with an alarm and rise at the same timeeach day, even at weekendsTwo alarm clocksIt may be helpful to set two alarm clocks.The client can take their medication when woken bythe first clock in order to improve their concentration and focus for their morning routine.Theclient should also set a second alarm clock at a time when their medication is likely to have begunacting [ Pobierz całość w formacie PDF ]