Sleep Enhancement Intervention
Sleep problems are often associated with depression, anxiety, panic, physical illnesses, trauma, and in most cases, with ongoing stress. In order to develop an effective treatment plan, we have to take into consideration all concurrent conditions and to identify possible reasons for sleep dysfunction. In diagnosing and treating dyssomnias and parasomnias, including onset and chronic insomnias and early morning awakening, the following effective strategies can be implemented:

• Multi-modal sleep therapy, i.e., challenging negative intrusive thought patterns, racing thoughts, and restructuring behavioural patterns. This involves relaxation training, which reduces somatic tension; changing cognitions regarding sleep and insomnia; filling out daily activity and sleep logs; re-evaluating sleep schedules; and establishing wind-down and anchor (wake up) times. The relaxation module, with deep diaphragmatic breathing and muscle relaxation, followed by meditation and visual imagery (creating pleasant and soothing mental images), proves to be extremely effective for many patients.



• Lifestyle Changes: avoiding large meals, controlling caffeine and alcohol consumption (to prevent rebound insomnia upon metabolism); restricting physical activities, mentally challenging activities, watching emotionally-charged programs on TV.
  
  
• Stimulus-control therapy can be used to re-associate bed and bedroom with sleep, and to establish a firm sleep and wake-up schedule. It is important to create a relaxed and cozy atmosphere; have complete darkness in the room; to remove anything or anybody preventing one from falling asleep (e.g., TV, pets, snoring spouses); and learning strategies to maximize sleep enhancement.
  
  
• Sleep restriction, i.e., creating mild sleep deprivation, can also be implemented. For example, patients have to learn to refrain from evening napping in front of the TV. Some research recommends avoiding naps during the day; however, for some people, having 1-2 short naps may actually improve sleep patterns, depending on the physical and mental condition of the patient.
  
  
• Paradoxical interventions can be effective for some patients and for certain types of insomnia. The patient is told to remain passively awake, and not to exert any effort to fall asleep. It is deeply intertwined with cognitive restructuring, as the patient has to re-evaluate his or her beliefs about insomnia, and to get rid of performance anxiety. Even more active paradoxical interventions are possible with patients with high levels of resistance to treatment, such as displaying stubbornness or a compulsive need for self-control. In these cases it is possible to prescribe one not to sleep until a certain timeline. As with any paradoxical interventions, every factor should be carefully considered before enacting.
  
  
• Sufficient exposure to daylight is important for regulating circadian rhythms. Patients should increase their sun exposure; in the winter time, light therapy can be implemented.