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ABSTRACT

Dream therapist application of sleep hygiene principles in clinical practice.

Barry Krakow, MD., Associate Research Professor of Emergency Medicine and Psychiatry at the University of New Mexico Health Sciences Center, Albuquerque, New Mexico, Medical Director, UNM Sleep Research.  Address:  Barry Krakow, M.D. UNM Sleep Research, 4775 Indian School Rd.  NE, ABQ. NM 87110.   bkrakow@salud.unm.edu.  Background:  Dr. Krakow is a board certified sleep disorders specialist and former medical director of the University of New Mexico Sleep Disorders Center.  He has extensive experience in treating patients with the combination of insomnia and nightmares.

In working with chronic nightmare sufferers both with and without PTSD, I have been struck by the severity of their insomnia complaints, but even more so, by the response they often have to simple sleep hygiene instruction. Sleep hygiene instruction is predicated on a series of "rules" that tend to be observed in most healthy sleepers and, which, when applied to insomniacs, can help them regain some normalization of their sleep and sleep patterns.
The classic example of sleep hygiene application is to learn not to watch a clock while in bed. From a psychological conditioning aspect, clock-watching leads to an association between not sleeping and laying awake in bed and therefore causes or promote further insomnia. Interestingly, though, many patients do not necessarily accept this rule (to not watch the clock) because they are likely to have deeply ingrained beliefs about the nature of time and how time impacts upon their sleep. Sleep specialists and other practitioners who simply tell their clients to not look at the clock often discover that their patients won't do it or they will do it half-heartedly. The result is a poor response to sleep hygiene principles. By delving more deeply into the patient's cognitive distortions about the nature of time and other fixed beliefs about keeping track of time slept, the patient is much more likely to give sleep hygiene techniques a more sincere and extended trial.
In the workshop, we will discuss all the basics of sleep hygiene and delve into patient belief systems about why sleep eludes them. Learning to use sleep hygiene principles in this fashion guarantees a much higher level of success in its application. Participants will be encouraged to discuss cases or situations which they have already come upon in their practice of dream work. As such, participants are welcome to share specific, brief case histories for discussion.
We will also spend time talking about simple screening questions to ask patients about more severe sleep disorders. For example, how beneficial might it be to ask a patient if they snore? This information can all be handled in an educational manner and in no way constitutes the practice of medicine. Thus, dream therapists can be assured that both sleep hygiene information and simple screening questions about sleep disorders fall within the scope of their practice. More importantly, all of this information is likely to add a new dimension to the dream therapist's practice, while being of considerable benefit to the client.