2.3* penn session - 3 compliance & sleep hygiene - 2014
TRANSCRIPT
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INSOMNIA SESSION 3 – TREATMENT
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“WHAT ARE WE GOING TO DO TODAY?” THE SAME THING AS EVERY DAY … !
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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60 45
25 45
300 347
40
50
330
SESSION – 3 POST FIRST WEEK OF ACTIVE TX
NO CHANGE
NO CHANGE
NO CHANGE
GRAPH MEAN SLEEP CONTINUITY – SCENARIO 1
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NO CHANGE
GWEN COMPLAINS
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DID THE PATIENT SLEEP RESTRICT ?
THEY SAID
“I DID” “ I WANTED TO BUT COULDN’T”
“I DIDN’T WANT TO”
DID THE PATIENT PRACTICE STC ?
THEY SAID
“I DID” “ I WANTED TO BUT COULDN’T”
“I DIDN’T WANT TO”
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THEY SAID
“I DID”
DOES THE DIARY REFLECT THIS ??
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WAS THERE A DELAY IN TTB ? WAS MOST OF THE WASO SPENT OUT OF BED ?
REVIEW INSTRUCTIONS ASSESS OBSTACLES
ASSESS WHETHER SRT WAS
POTENT ENOUGH
COMPLIANT
NOT COMPLIANT
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DID THE PATIENT SLEEP RESTRICT ? DID THE PATIENT PRACTICE STC ?
THEY SAID
“ I WANTED TO BUT COULDN’T”
“NO PAIN NO GAIN” MAYBE DELAY TX ?
THEY SAID
“ I DIDN’T WANT TO”
DISCUSS DELAYING
TX
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60
25
300 347
GRAPH MEAN SLEEP CONTINUITY – SCENARIO 1
SESSION – 2 TREATMENT INITIATION
285 300 347 240
60 45
25 45
300 347
15
20
297
SRT APPLIED TST = 297 TIB = 330
?
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60
25
300 347
GRAPH MEAN SLEEP CONTINUITY – SCENARIO 1
SESSION – 2 TREATMENT INITIATION
285 300 347 240
60 45
25 45
300 347
15
20
297
SRT APPLIED TST = 297 TIB = 330
TST/TIB = 90%
UPWARD TITRATE
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60 45
25 45
300 347
GRAPH MEAN SLEEP CONTINUITY – SCENARIO 2
SESSION – 2 TREATMENT INITIATION
25
20
285
SRT APPLIED TST = 285 TIB = 330
?
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60 45
25 45
300 347
GRAPH MEAN SLEEP CONTINUITY – SCENARIO 2
SESSION – 2 TREATMENT INITIATION
25
20
285
SRT APPLIED TST = 285 TIB = 330
TST/TIB = 86%
STICK !
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GRAPH MEAN SLEEP CONTINUITY – SCENARIO 3
SESSION – 2 TREATMENT INITIATION
60 45
25 45
40
50
300 347 240
SRT APPLIED TST = 240 TIB = 330
?
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GRAPH MEAN SLEEP CONTINUITY – SCENARIO 3
SESSION – 2 TREATMENT INITIATION
60 45
25 45
40
50
300 347 240
SRT APPLIED TST = 240 TIB = 330
TST/TIB = 72%
CONTINUE DOWNWARD
TITRATION
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THE CALCULATION OF SLEEP EFFICIENCY
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THE PATIENT’S WAY
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THE THERAPIST’S WAY
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LET’S SPEND SOME TIME WITH THIS
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THERE IS NO PERFECT RULE
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RULE OF THUMB
For TIB whatever makes TIB bigger, provided the patient wanted/was trying to sleep.
in bed early: counts in bed late - due to schedule: doesn't count
out of bed early - due to EMA: counts out of bed early - due to schedule: doesn't count
For TST whatever makes TST smaller
time awake out of bed: counts
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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SLEEP HYGIENE IS NOT THE 10 COMMANDMENTS
IT IS NOT EFFECTIVE AS A MONOTHERAPY MANY OF ITS TENETS ARE UNTESTED
SEVERAL OF THE IMPERATIVES MAY BE “WRONG HEADED”
BEST TAILORED TO THE INDIVIDUAL BEST USED TO HAVE PATIENT BETTER “GROK” SLEEP
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INTRODUCING SLEEP HYGIENE THE 30 SEC. VERSION
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INTRODUCING SLEEP HYGIENE THE 5 MINUTE VERSION
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READER
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
A BIT OF HUMOR BEFORE DEBUNKING
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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“Sleep (is like) a dove which has landed near one’s hand and stays there as long as one does not
pay any attention to it; if one attempts to grab it, it quickly flies away”
Viktor E. Frankl (1965, p. 253) cited in Ansfield et al. Behav.Res.Ther. 1996;34:523-531
SLIDE PROVIDED BY COLIN ESPIE
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
I CAN’T RESIST SOME EXAMPLES HERE
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GIFT IDEAS FOR PEOPLE YOU HATE WHO HAVE INSOMNIA
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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SESSION – 3 POST FIRST WEEK OF ACTIVE TX
INTERESTING – NO WHERE IS THERE A MENTION OF
NIGHT TIME LIGHT EXPOSURE
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WHAT ABOUT LIGHT EXPOSURE ?
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THE PROBLEM
SLIDE PROVIDED BY SIGRID VEASEY
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THE PROBLEM
SLIDE PROVIDED BY SIGRID VEASEY
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THE PROBLEM
SLIDE PROVIDED BY SIGRID VEASEY
4am
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A SOLUTION
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A SOLUTION
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ANOTHER SOLUTION
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ALL THIS SAID MAYBE LIGHT’S NOT SUCH A PROBLEM
VS.
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QUESTIONS & RESISTANCES
I JUST CAN’T STAY AWAKE UNTIL THE PRESCRIBED BEDTIME ?!
IRONY
I JUST CAN’T GET OUT OF BED
SLEEP OF REASON
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NEXT WEEK
REVIEW YOUR SLEEP DIARY DATA
TITRATION & TROUBLE SHOOTING
SESSION – 3 POST FIRST WEEK OF ACTIVE TX
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BREAK