23: EXERCISE                                                                       [Rev 1-26-2019]

This is one of the treatment sections referred to in Step C (Section 40)

It is possible that a person is not tired at bedtime because his/her body is not finished with the day, and that could be because the person isn’t getting enough exercise. At one extreme, a person who hangs out on the couch all day may be thoroughly rested, may already have had several naps, or may otherwise be unable to distinguish sleep time from the rest of the day. At the other extreme, unusually strenuous exercise in the day can interfere with sleep the following night. However regular, moderate amounts of exercise help a person go to sleep more easily and promote deep sleep Hauri and Linde p.132).

23a. Amounts

It is generally agreed that regular exercise maintains health and supports normal sleep. In addition, periods of aerobic exercise for 20-30 minutes, 3-4 times a week can promote slow-wave sleep, which is physically restorative (Reite, Weissberg and Ruddy, p.79).Exercise tires a person and increases general physical fitness, both of which can help improve sleep (Hauri and Linde, p.132).

23b. Timing

It also matters what time of day a person exercises. Early morning exercise may have physical benefits, but it has little direct impact on a person’s sleep (Morin, p.152).

Body temperature follows circadian patterns, being normally a couple of degrees higher in daylight hours and lower at night. Exercise can be timed to support that natural rhythm if it is carried out about 4-5 hours before bedtime. Then it not only raises body temperature in late afternoon or early evening; cooling-off can be timed to occur at about bedtime, helping to promote sleep onset (Sack, p.187; Friedman, Zeitzer and Mumenthaler, p.263)

However, exercise within 3 or 4 hours of sleep may be energizing and interfere with the ability to drift off.

23c. Kinds of Exercise

The kind most likely to promote sleep is vigorous exercise that increases heart rate and body temperature (Hauri and Linde, p.133). Stretching and flexibility training may have value in themselves without having direct effects on sleep.

Within the range of vigorous exercise, there are many possibilities, including walking, running, bicycling, swimming, basketball, tennis, rowing, etc. It can be alone or in a group setting; indoors or outdoors. It can require elaborate equipment or nothing. It can be competitive or not. Some people can find satisfaction exercising to television videos. A person’s choice depends on his/her age, physical condition, medical state, and interests.

23d. Making it Happen

It is one thing to recognize the value of exercise and another to maintain a regular exercise program over time. The normal tendency for most people is to begin, then find reasons not to follow through. Any plan needs to be tailored to the abilities and limitations of the patient, and a therapist will probably need to help with the planning and follow-through.

Getting started can involve finding exercise modes that are

  • familiar to the person
  • interesting and potentially satisfying
  • available

Bourne (pp.97-101) has some interesting suggestions for helping a patient choose a kind of exercise and for getting started.

Several things can be done to help a person keep exercising:

  • Suggest that he/she start at a rate that is unintrusive –a very small amount easily inserted into the day. Then build up over time. For example, one person started running at the age of 50, jogging a hundred feet the first day, the same the second and third days. On the fourth, she jogged a hundred feet, stopped, and jogged back. When she was ready, she did more. After a year, she was able to compete in local road races.
  • Recommend exercising at the same time every day, making it a habit.
  • Suggest he/she commit to an exercise class or group activity. The cost of participation or the social pressure from other group members can be an incentive to keep going.
  • Have him/her announce the change and report – to family members, friends, co-workers, etc.
  • As therapists, we can support the effort by asking every session, encouraging, interpreting defenses, or providing a record sheet for the person to keep track.

 

References

A good overall treatment of the relationship between exercise and sleep appears in Hauri and Linde, Chapter 23, pp.132-140