45:  CHOICE OF CALMING TECHNIQUES                         (Revised 9-17-2017)

This section provides more detail about the choice when a patient is too agitated to get to sleep. It is essentially a bridge between Section 17 and the various treatments for excess energy .

It is not unusual for some people to be tired at bedtime, yet be unable to “slow down” enough to get to sleep. There is an apparent physiological drive, an energy level that is still going. In bed, they toss and turn, can’t get comfortable, and are generally miserable.

For a person who is sleepy but who also has a surplus of energy at bedtime, calming techniques can be helpful. They include:

• Have a buffer period before bed (Section18)
• Set aside worry-time (Section 19)
• Find Ways to Unwind (Section 21)
• Use yoga (Section 39)
• Develop bedtime rituals (Section 37)
• Use relaxation techniques (Section 24)
• Avoid sleep medications (Section 36)

These have a common theme of placing an emotional and energy barrier between the activities of the day and the quiet of bedtime.

AFTERNOON AND EVENING

• Some people have recommended dealing with worrisome issues in a separate time not close to bedtime (Section 19). This may reduce the need to focus on those issues as one is starting to relax. Should the troublesome thoughts come up at bedtime, the person can remind him/herself that they have already been dealt with or will be dealt with the next day.
• Yoga (Section 39)

 

BEFORE BED

• Having a buffer period of half an hour or more when the person does nothing either emotionally stimulating or related to daytime activities (Section 18). It may allow the energy of the day to dissipate and help to set the stage for a wind-down into sleep.
• Bedtime rituals (Section37) provide a signal that the day is over and sleep is the next agenda item. Done calmly, they can contribute to the buffer period.
• Medication can be a temporary solution when agitation is accompanied by anxiety (Section 36) but there is a danger of physical or psychological dependence, side effects, and loss of self-esteem.
• Relaxation Techniques

 

IN BED

• There are a number of procedures to relax directly that a person can try, including systematic relaxation (Section 24), a hot bath, meditation, yoga (Section 39) or self-hypnosis. The choices among these options are considered in Section 24 and links are make to other sections and resources.
• It is also possible that increasing the person’s sleepiness could interfere with obsessive thinking, so limiting the time the person spends lying awake (Section 34) or sleep restriction (Section 29) could be helpful.
• Finding some way to unwind (Section 21). These techniques can be used to direct thoughts away from daily events and toward thoughts that are more compatible with sleep.