30 INTERRUPTION MANAGEMENT

This is one of the issues with interrupted sleep. It follows Section 48 of Step D3.

A number of issues have already been considered for treatment when the person awakens in the middle of the night and can’t return to sleep.

PHYSIOLOGICAL AND BIOLOGICAL NEEDS

Temperature management

If this is a recurrent problem, something may need changing in the environment. Consider the suggestions of Section 5.

Activity in the bed or bedroom See Section 5.

The need to urinate. Here are some suggestions:

  • Make a clear choice about getting up or not. Carry it out.
  • If you go, focus only on the process of relief, note your success, and return to bed satisfied. Keep the lights low or off. Move as little as possible. Stay sleepy.
  • If you don’t go, try shifting position in bed.

When the problem is recurrent:

  • Manage liquid intake; plenty during the day, very little during or after dinnertime.
  • Manage alcohol and other drugs

Hunger or thirst

  • Get up, eat or drink the minimum to address the impulse
  • Avoid anything stimulating. Stick with a cracker and a couple of ounces of milk
  • Avoid bright lights, which can affect a person’s sleep cycle

THOUGHTS AND IDEAS

When the process of waking and/or getting up in the night sets off a train of thoughts or actions that lead to difficulty returning to sleep, it may be possible to manage the interruption more effectively.

A main goal is not to consider daytime events consciously if possible, because to do so may increase the difficulty of returning to sleep.

Thoughts about current events or issues.

The person awakens with a thought that won’t go away. It could be disturbing or just persistent. It needs to be taken off the front burner so sleep can return, perhaps by using…

  • A mantra: ”I will be just as smart tomorrow, and I will be able to look up relevant information. Let it go for now.”
  • A resolve: “That’s messed-up. Better take it to therapy this week and figure it out.”
  • An action: keep a pad and pencil next to the bed or toilet. Get up and write it down, so you won’t forget it.

An idea that wants to be examined. The person can…

  • Keep a recording medium ( pad and pencil, recorder) nearby and make a note of the idea.
  • Decide to review the note the next day
  • Consider that his/her unconscious will continue to work on the problem during sleep.

Dreams and Nightmares

Dreams can be handled in a variety of ways. We can think of them as ways of processing daytime events and concerns without the limitations of logic and external reality. If they are remembered, they can be examined and used to shed a different light on the person’s psychological issues.

Remembering a dream is not a problem unless the person wants to remember it or it is disturbing and the memory of it prevents a return to sleep.

If a dream prevents returning to sleep, the person should consider getting up and

  • writing the dream down in enough detail so that general themes can be remembered the next day, then either
  • re-telling the dream consciously to yourself, so it moves in a benign direction or
  • thinking about something else, something benign or mundane. Then try returning to sleep with different thoughts in mind.

The person should also consider returning to it the next day or in psychotherapy, to look for themes or underlying issues that need to be addressed.

Especially violent, disturbing and recurring dreams may reflect underlying issues such as fears, rage, or post-traumatic stress.