Action Plan for Nighttime arousal

One of the most vexing problems that we encounter in our program is the problem of nighttime arousal.  Often there is a stimulus to get up like having to urinate, but then the patient lays awake in bed often for hours before falling back to sleep.  This problem is like the sleep anxiety problem that can cause difficulty with latency at the beginning of the evening.  But in this situation, it can be worse because of the natural physiology of sleep.  When you fall asleep there is an immediate drop in the neurotransmitters that cause you to feel sleepy.  When you awaken several hours later, those neurotransmitters are much lower than they were previously, so you may not feel as sleepy as you did before. If you then become anxious about getting back to sleep, then you can find yourself lying awake sometimes for hours and then dozing off in the morning.  Overall this can make for a very bad night of sleep.  To break this cycle, you need to adopt a version of the sleep anxiety intervention described in the first set of interventions.  You need to get out of bed so that you don’t create negative associations with the bed itself and you need to move to a comfortable chair in another room and do a quiet can calming activity until you feel sleepy enough to go back to sleep.  Then quietly get back into bed and make sure that the room is cool and dark.

The experiment for nighttime arousal is a little different than the other sleep intervention experiments.  In this experiment, you will look at duration, overall sleep quality and Epworth score.  You will want to keep careful notes about the arousals and how you handled them.  Do this for 2 weeks and if you see improvements in duration and quality then continue to incorporate you new nighttime arousal plan into your program.