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"Do night lights cause cancer?" is the title of a blog post written by biofeedback expert and PhD psychologist Dr. Erik Peper. Follow the link above and you can decide for yourself if the post is compelling. Researchers in this study published in the Cleveland Clinic Journal of Medicine asks "Does lack of sleep cause diabetes?" Poor sleep quality or not enough hours of sleep are often considered as precursors to health impairments as the body does much of its cellular regeneration and other restorative functions during the sleeping hours. These questions and concerns bring us to the concept of "Sleep Hygiene." 

 

The American Academy of Family Physicians has published this full text article that describes several components of insomnia treatment, including sleep hygiene. Reasons for insomnia may include anxiety, depression, fibromyalgia, sleep apnea, menopause, pain, or restless legs syndrome. Medications that can contribute to lack of sleep include alcohol, nicotine, caffeine, diuretics, beta blockers, and stimulant laxatives. The authors describe sleep hygiene as one part of a cognitive behavioral therapy (CBT) approach to treat insomnia, which can be comprised of 4-8 sessions. Each session may be 60-90 minutes long and topics covered may include behavioral education for stimulus control, sleep restriction, relaxation therapy, and paradoxical intention (trying to stay awake.)

 

The concepts included in sleep hygiene (adapted from the above study) are as follows:

 

  1. Avoid caffeine and nicotine, particularly before bedtime.
  2. Avoid exercise 4 hours prior to bedtime.
  3. Avoid large evening meals.
  4. Avoid taking naps during the day.
  5. Rise and sleep at same times each day (even on weekends!)
  6. Keep a comfortable temperature in bedroom.
  7. Keep the bedroom very dark.
  8. Set aside time to unwind or use relaxation techniques before bed.
Patients may also find concepts in "stimulus control" very useful as patients are instructed to only associate the bedroom with sleep and sexual activity- no television! Some of the relaxation strategies referenced in this study include autogenic training, biofeedback training, imagery training, progressive relaxation and paced respirations. 
The above are all strategies that a pelvic rehabilitation provider can effectively teach to her patient. If your patient's recovery may be limited by pain, medications, anxiety, and the unfortunate sequelae of sleep loss, education in the concepts described here can be practical ways to help the patient affect her sleep. The authors reference a meta-analysis by Perlis et al. (2003) that finds that CBT for general insomnia is comparable to pharmacotherapy, and that CBT for sleep-onset insomnia is superior to pharmacotherapy. It is also pointed out in this article that most patients can self-administer the sleep treatments once instructed. Consider guiding your patients to strategies for improved sleep, with the intention of helping patients to improve the bodies time in restful recovery.

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written by sac a main lancel, March 10, 2012
CTYLTQBHLWMHRN
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