Behavioral Interventions with Sleep Disorders

The "Be a Sponge" Technique for Relaxation
In the last section, we discussed behavioral interventions for breathing related sleep disorders.  There are several types of breathing related sleep disorders for which exist a limited number of treatment options.

In this section, we will discuss techniques for relaxation.  For the purposes of sleep disorders, we will discuss three techniques for relaxation.  The three techniques for relaxation that we will discuss are stretching, mind games, and autogenic training.  As you listen to this track, you might consider the application of these techniques to your clinical setting.  Could your client benefit from stretching, mind games, or autogenic training?

3 Techniques for Relaxation

Technique #1 - Stretching
First, let’s discuss relaxation and stretching. Holly, age 29, was a sleep disorder client of mine.  Holly’s main complaint was insomnia as a secondary sleep disorder.  After Holly’s diagnosis interview, I discovered that the cause of Holly’s insomnia was muscular discomfort and pain. It also seemed possible that Holly was experiencing involuntary limb movement in her sleep as well. When I discussed Holly’s case with a colleague, I learned that some simple stretching exercises often benefited clients like Holly. I described several of these stretching techniques to Holly.

Five Stretching Techniques
-- Stretch # 1: I stated, "The first stretch you may want to consider trying is the ‘rag doll dangle.’  Stand with your legs apart and bend at the waist.  Shake your arms and hands loosely. Let your head hang and sway from side to side.  Shrug your shoulders.  Hang loosely for a few moments to relax completely. 

-- Stretch # 2: Next, try the ‘head roll.’ Drop your chin to your chest.  Rotate your head to the right and turn your chin to your shoulder.Circle the head back and around and over your left shoulder to make a complete revolution. Repeat in the opposite direction." 

-- Stretch # 3: In addition to the ‘rag doll dangle’ and the ‘head roll’, the third stretch I recommended to Holly was the ‘full body stretch.’ I stated, "Extend your right arm straight up and reach for the ceiling.  Reach as high as you can. Pretend you’re picking dollar bills off the ceiling.  You should feel your entire right side stretch from the fingers of your right hand to your right foot.  Repeat the stretch with your left arm."

After I described these three stretches to Holly, she reiterated the specifics and degree of pain that kept her awake.  Holly stated, "My shoulders and back hurt the most. Do you have any stretches that can help those muscles?" Clearly, I had been providing Holly with techniques that were not applicable to her specific problem. 

-- Stretch # 4: I then stated, "Perhaps you should try the ‘shoulder stretch.’ Sit on the edge of a chair with your knees apart and your feet on the floor.  Place your hands on your knees with your elbows slightly bent.  Press your hands into your knees and lean forward. Rotate your shoulders and ribs to the left and then to the right." 

-- Stretch # 5: To help Holly with her back pain, I then described the ‘back stretch’ to her.  I stated, "Lie flat on your back in bed. Push your spine into the bed, flattening your back and pulling in your abdomen.  Release, go limp in all muscles, and breathe deeply. Repeat several times.  After the last time, remain limp and breathe deeply." 

As I did with Holly, you may want to inform your client that before he or she begins any type of exercise, he or she should first consult a physician.  After Holly’s physician cleared her for this type of exercise, Holly began a nightly stretching routine that began to benefit her. Could relaxation through stretching benefit your client?

Technique #2 - Mind Games
Regarding relaxation, I have found that a second group of techniques that often helps sleep disorder clients is mind games. Overly alert and tense sleep disorder clients may find these three techniques useful to help them drift off to sleep. The three mind game techniques that we will discuss are ‘be a sponge,’ ‘the sighing breath,’ and ‘creating pictures.’

3 Mind Game Techniques
-- Mind Game # 1: Be a Sponge
Randall, age 46, used the ‘be a sponge’ technique to fall asleep in spite of his periodic episodes of insomnia. When I described the ‘be a sponge’ technique to Randall I stated, "Lie on your back, completely relaxed, and imagine you are a sponge.

" Let your arms lie limp and away from your body, relax your shoulders, and relax your legs. Close your eyes and breathe deeply through your nose.  Let each part of your body relax while imagining that you are a sponge soaking up peace and tranquility." At a later session, Randall stated, "When I do the ‘be a sponge’ thing, I like to look out my window. It helps me relax and I like to think about soaking up the peaceful night outside." 

-- Mind Game # 2: The Sighing Breath
A second mind game technique is ‘the sighing breath.’ You might consider suggesting to your sleep disorder client that he or she inhale deeply through the nose and then exhale slowly through the mouth for as long as possible. When your client concentrates on the long sighing sound, he or she may begin to feel tension dissolve.

-- Mind Game # 3: Creating Pictures
In addition to ‘be a sponge’ and ‘the sighing breath,’ a third mind game technique is ‘creating pictures.’ Do you recall Mariah from the mental imagery track? Mariah used the ‘on vacation’ technique to help her fall asleep. However, some clients may become so distracted by such an involved visualization technique that they can’t get to sleep. Jackson, age 34, was a sleep disorder client who had an active mind which contributed to his insomnia. I found that by focusing Jackson’s attention to the ‘creating pictures’ technique, he could actually slow his thinking down enough to go to sleep.

During one of our sessions, I asked Jackson to close his eyes and pay attention to the various patterns and colors on the inside of his eyelids.  Jackson stated, "OK.  I see them."  I responded, "Good.  Now, if you’d like, when you go to bed tonight close your eyes and focus on those colors and patterns. In a dark room, you might find that with enough thought you can not only see different patterns and hues, but you might also see them continually blending and changing. See if you can influence the changes in color or pattern through thought."

Think of your Jackson. Could a technique like ‘creating pictures’ help your client slow down an active mind?

At a later session, Jackson stated, "I don’t know if my eyes are playing tricks on me or what, but there are definitely changing colors, even in the dark." 

Jackson’s preoccupation with the ‘creating pictures’ technique began to help him get to sleep.  What about your sleep disorder client? Could he or she benefit from these mind game techniques? Would trying these techniques yourself help you better apply them in your practice?

Technique #3 - Autogenic Training
In addition to stretching and mind games, a third method for sleep disorder clients to relax is autogenic training. As you probably know, autogenic training regarding sleep disorders is a procedure that involves repeating the same phrases over and over while concentrating on feelings of heaviness and warmth. The idea is that through the client’s own suggestion, ‘heavy’ muscles relax and ‘warm’ flesh receives better circulation. An experiment by Kahn, Baker, and Weiss revealed the benefits of autogenic training. 

Kahn, Baker, and Weiss taught 16 insomnia college students to use autogenic training. Each student began by thinking the phrase, "My right arm is heavy," repeating it several times. Students then focused on other areas of the body.  Later, the students continued with "My arms are warm," "My legs are warm," "My entire body is warm." 

At the end of the study, Kahn, Baker, and Weiss found that the students had cut their average time needed to fall asleep from 52 to 22 minutes. These same results were matched in a different study by Dr. Richard Bootzin, who found that a month’s daily practice of autogenic training produced 50 percent improvement in falling asleep.

If you are treating a client who suffers from insomnia or has trouble falling asleep, have you considered autogenic training? If not, you might consider implementing this technique, or perhaps some of the other techniques on this track.  Perhaps you don’t currently have a sleep disorder client. Is a colleague currently treating a sleep disorder client?  Could playing this track benefit him or her?

In this section, we have discussed techniques for relaxation. For the purposes of sleep disorders, we discussed three techniques for relaxation. The three techniques for relaxation that we discussed were stretching, mind games, and autogenic training. 

In the next section, we will discuss taking control. We will examine worry time and reducing tension and coping with stress. 
Reviewed 2023

QUESTION 13
What are three techniques for relaxation regarding sleep disorders? To select and enter your answer go to Test.