Sleep/Wake Disturbances

Term

Definition

Cognitive-behavioral therapy

This variety of psychological and behavioral treatments can be used alone or in combination; more than 20 treatments have been developed. The most frequently used treatments are stimulus control therapy, sleep restriction therapy, relaxation therapies, paradoxical intention, and sleep hygiene education.⁵

Cognitive restructuring

Cognitive restructuring is a process in which maladaptive or false cognitions are identified, reevaluated, or reinterpreted into a more adaptive and presumably functional belief, attitude, or expectation.²⁷

Complementary and alternative medicine

Complementary and alternative medicine is a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine and is used to complement or as an alternative to traditional medicine.³²

Exercise

Any planned, structured, and repetitive bodily movement performed during leisure time that incorporates cardiovascular, strength, and/or flexibility conditioning of any intensity with the intent of improving or maintaining one or more components of physical fitness, performance, or health.^33,34

Expressive therapy

This therapy is conducted in a group or individual setting that is existentially oriented; the focus is on meaning, freedom, and isolation as a result of illness. The therapy facilitates patients' ability to discuss concerns and issues that are foremost in their minds as opposed to what a leader or outsider thinks is important.³⁵

This is the art of putting thoughts and feelings on paper.²²

A technique in which a "healer" attends to the person with illness in an attempt to catalyze the healing process without using any known physical means of intervention. Forms of healing include prayer, concentration, or touch.^24,36

These dietary supplements contain herbs, either singly or in mixtures. An herb (also called a botanical) is a plant or plant part used for its scent, flavor, and/or therapeutic properties.³⁷

Massage therapy

This ancient form of healing involves the therapeutic manipulation of soft tissues of the body by various hand movements (e.g., rubbing, kneading, pressing, rolling, slapping, tapping). Massage therapy can elicit the relaxation response as measured by decreases in heart rate, blood pressure, and respiratory rate. Often, massage is complemented by the use of aromatherapy (i.e., essential oils that are combined with a carrier cream or oil to manipulate the soft tissues).³⁸

Meditation

Mental exercises are used to purposefully self-regulate attention and attain physical calm. The intent is to quiet the mind and focus on the present. This can bring about a deep state of relaxation.³⁹

Mindfulness-based stress reduction

This can be thought of as a consciousness discipline that is aimed at deep self-reflection, self-knowledge, and liberation from confining views of self, others, and the world. The main components include the body scan, simple yoga postures, and mindful meditation.^{14, 40}

Parodoxical intention

This method consists of persuading patients to engage in their most feared behavior such as staying awake. It focuses not on trying to sleep but instead attempting to stay awake to reduce performance anxiety.⁵

Progressive muscle relaxation

This relaxation focuses on isolating various muscle groups while moving progressively up or down the body to establish a state of deep relaxation. Focused breathing, with all attention centered on the sensations of breathing, including the rhythm and rise and fall of the chest, often is used with this technique.⁴¹

Psychoeducational interventions

These include cognitive behavioral techniques; informational, instructional, and teaching approaches; and related supportive strategies designed to elicit behaviors that promote effective self-management and strengthen coping. Examples of psychoeducational interventions include techniques that promote adherence to healthcare professionals' recommendations, enhance self-management, optimize attributions and illness representations, and strengthen coping.²⁶

Relaxation therapies or techniques

The therapies or techniques, such as autogenic training, progressive muscle relaxation, and massage therapies, reduce somatic and/or cognitive arousal.⁵

Sleep hygiene

Health practices (e.g., diet, exercise, substance use) and environmental factors (e.g., light, noise, temperature) may be detrimental or beneficial to sleep. It also may involve basic information about sleep and changes in sleep over the lifespan.⁵

Sleep restriction therapy

This therapy consists of curtailing the amount of time spent in bed to the actual amount of sleep.⁵

Sleep-wake disturbance

These are perceived or actual alterations in night sleep with resultant daytime impairment. Among the most common sleep disturbances are insomnia, sleep-related breathing disorders, and sleep-related movement disorders (e.g., restless leg syndrome, periodic limb movement disorder). General criteria for insomnia include difficulty initiating sleep, difficulty maintaining sleep, waking too early, or sleep that is chronically unrestorative or poor in quality that occurs despite adequate opportunity and circumstances for sleep. Characteristics of sleep-wake disturbances are measured by the following nine parameters.

•  Total sleep time while in bed : the number of minutes of sleep while in bed

•  Sleep latency : the number of minutes between laying down in bed to actually falling asleep

•  Awakenings during sleep period : the number of awakenings during sleep period

•  Wake time after sleep onset: the number of minutes awake or percentage of time awake after sleep onset during the sleep period

•  Napping during the day: the total number of minutes of sleep during the daytime; can be intentional or unintentional

•  Excessive daytime sleepiness : episodes of lapses into sleep of short duration, usually in situations in which the person is inactive for even brief periods; can result from acute or chronic sleep deprivation or loss or other pathophysiologic causes

•  Quality of perceived sleep : multidimensional perceptions of length and depth of sleep and feelings of being rested on awakening; subjective assessment of sufficiency of sleep for daytime functioning

•  Circadian rhythm : biobehavioral phenomenon associated with fluctuations in light, hormones, eating, and/or socializing that repeats every 24 hours

•  Sleep efficiency : the number of minutes of sleep divided by the total number of minutes in bed multiplied by 100²

Yoga

This ancient Eastern science incorporates stress-reduction techniques such as regulated breathing, visual imagery, and meditation as well as various postures. Hatha yoga is one type of yoga.^14,20