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Improving Your Sleep Using Mindfulness

and Other Neurobiological Tools

Mindfulness & Neurobiological 

Tools for Healing - A Training Resource

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T

Sleep Hygiene Guidelines


Sleep only as much as needed to feel refreshed the following day

  • Restricting time in bed helps consolidate and deepen sleep. Spending excessive time in bed can lead to fragmented and shallow sleep.


Have a routine wake up time, seven days a week

  • A regular wake up time in the morning will help set your “biological clock” and leads to regular sleep onset.


Your bedroom should be comfortable and free from light and noise

  • A comfortable bed and bedroom environment will reduce the likelihood that you will wake up during the night. Excessively warm or cold rooms can disrupt sleep as well. A quiet environment is more sleep promoting than a noisy one. Noises can be masked with background white noise (such as the noise of a fan) or with earplugs. Bedrooms may be darkened with black-out shades or sleep masks can be worn. Position clocks out-of-sight since clock-watching can increase anxiety about lack of sleep.


Caffeine: Avoid Caffeine 4 - 6 Hours Before Bedtime

  • Caffeine disturbs sleep, even in people who do not subjectively experience such an effect. Individuals with insomnia are often more sensitive to mild stimulants than are normal sleepers. Caffeine is found in items such as coffee, tea, soda, chocolate, and many over-the-counter medications (e.g., Excedrin).


Nicotine: Avoid Nicotine Before Bedtime

  • Although some smokers claim that smoking helps them relax, nicotine is a stimulant. Thus, smoking, dipping, or chewing tobacco should be avoided near bedtime and during the night.


Alcohol: Avoid Alcohol After Dinner

  • A small amount of alcohol often promotes the onset of sleep, but as alcohol is metabolized sleep becomes disturbed and fragmented. Thus, alcohol is a poor sleep aid.


Sleeping Pills: Sleep Medications are Effective Only Temporarily

  • Scientists have shown that sleep medications lose their effectiveness in about 2 – 4 weeks when taken regularly. Despite advertisements to the contrary, over-the-counter sleeping aids have little impact on sleep beyond the placebo effect. Over time, sleeping pills actually can make sleep problems worse. When sleeping pills have been used for a long period, withdrawal from the medication can lead to an insomnia rebound. Thus, many individuals incorrectly conclude that they “need” sleeping pills in order to sleep normally.


Exercise/Hot Bath: Avoid Vigorous Exercise Within 2 Hours of Bedtime

  • Regular exercise in the late afternoon or early evening seems to aid sleep, although the positive effect often takes several weeks to become noticeable. Exercising sporadically is not likely to improve sleep and exercise within 2 hours of bedtime may elevate nervous system activity and interfere with sleep onset. Spending 20 minutes in a tub of hot water an hour or two prior to bedtime may also promote sleep.


Napping: Avoid Daytime Napping

  • Many individuals with insomnia “pay” for daytime naps with more sleeplessness at night. Thus, it is best to avoid daytime napping. If you do nap, be sure to schedule naps before 3:00pm.


Eating: A Light Snack at Bedtime May be Sleep Promoting

  • A light bedtime snack, such a glass of warm milk, cheese, or a bowl of cereal can promote sleep. You should avoid the following foods at bedtime: any caffeinated foods (e.g., chocolate), peanuts, beans, most raw fruits and vegetables (since they may cause gas), and high-fat foods such as potato or corn chips. Avoid snacks in the middle of the nights since awakening may become associated with hunger.


Avoid Excessive liquids in the evening

  • Reducing liquid intake will decrease the need for nighttime trips to the bathroom. Do not try to fall asleep If you are unable to fall sleep within a reasonable time (15-20 minutes) or when you notice that you are beginning to worry about falling asleep, get out of bed. Leave the bedroom and engage in a quiet activity such as reading. Return to bed only when you are sleepy.


Don’t have worry time in bed

  • Plan time earlier in the evening to review the day, plan the next day or deal with any problems. Worrying in bed can interfere with sleep onset and cause you to have a shallow sleep.

Ways to help you sleep better is to try is changing your sleep habits

For instance:

  • Go to bed the same time each night and get up at the same time each morning
  • Don't nap during the day
  • Stop stressful chores or discussions long before you go to bed
  • Relax before bedtime. Try deep breathing, prayer, gentle stretching, meditation, or journaling
  • Keep your bedroom dark, quiet, and cool. Use earplugs or eye shades if needed
  • Can't sleep? Go into another room and read, or do something relaxing and quiet
  • Avoid caffeine
  • Don't drink alcohol before bed
  • Quit smoking
  • Exercise regularly and maintain a healthy diet
  • Avoid large meals before bedtime
  • Remove electronics such as laptops, smart phones from the bed
Some Medical Reasons for Problem Sleeping
Here are just a few:
  1. Circadian Rythym Problems
  2. Snoring
  3. Sleep Apenea
  4. Narcolepsy
  5. Restless Leg Syndrome
  6. Age
Sleep - Amygdala-based Intervention
Sleep deprivation increases activation in amygdala.
REM sleep is particularly correlated with amygdala reactivity. More REM sleep, less reactivity.
Help clients see the effects of sleep deprivation and adequate sleep on their amygdala.
Point out how important REM sleep is, and how *extended* and uninterrupted sleep is essential to obtain the needed REM sleep.
More REM sleep results in less amygdala reactivity.

Effective Sleep Strategies

1. Before you go to bed, practice the same relaxing rituals to train your brain for sleep.

2. Eliminate light stimulation for at least one hour before bed. (This includes screens!)

3. Exercise during the day.

4. Establish a consistent bedtime and waking time.

5. Avoid napping.

6. If you have trouble falling asleep, replace activating thoughts with relaxing ones.

7. If worries haunt you at bedtime, schedule a worry time during the day.

8. Ensure that your sleeping environment is conducive to sleep.

9. Avoid caffeine, alcohol, and spicy foods in the late afternoon and evening.

10. Use relaxing breathing techniques to prepare for sleep.

11. If you can’t fall asleep after thirty minutes in bed, get up and do something relaxing in the

      dark.

12. Avoid prescription sleep aids. Melatonin is ok
Mindfulness: Using awareness & the focus of attention to transform
It will impact:
  • The Brain
  • The Immune System 
  • Sense of well-being 
  • Attention 
  • Relational Function 
  • Epigenetic Regulation 
  • Telomerase levels
Prior to Going to Bed Use Relaxation Breathing and Calm the Vagus Nerve
Use of Diaphragmatic breathing prior to settling down to sleep will help you fall asleep because:
  1. When a person uses belly breathing, the lungs are pressing on the diaphragm wall and the diaphragm is pushing the abdomen out.
  2. The abdomen also pushes out in the back, although you can’t see it, putting pressure on the spine.
  3. This puts pressure on the vagus nerve, the longest cranial nerve, which reaches all the way into the brain.
  4. The pressure quiets the vagus nerve down and turns on the relaxation system.
When the Vagus Nerve Quiets
  • Lowers blood pressure, heart rate, and respiration.
  • Removes lactate from the blood (lactate can increase feelings of anxiety).
  • Increases alpha brain waves (associated with calm alertness).
  • Releases serotonin (neurotransmitter that is stored in stomach lining and intestines and can increase feelings of satisfaction and pleasure).
  • Also activates the prefrontal cortex after 10+ minutes All this from breathing deeply!
Rule Outs When Dealing with Sleep Disorders

Major Symptom of Sleep Disorders is Insomnia

First “Rule Out” Insomnia Due to Physical Disorder

  • Gastro-esophageal Reflux Disease (GERD)
  • Hyperthyroidism
  • Periodic Leg Movement Disorder or Restless Legs Syndrome
  • Pain Syndromes

Second: Rule out Mental Health Disorders with Sleep-Related Symptoms

  • Depression
  • Bi-Polar
  • Post-Traumatic Stress Disorder
  • Dementia
  • ADHD
  • GAD
  • Traumatic Brain Injury
Facts About Sleep We Need to Know

Sleep & Circadians

You have 8 chemical bodies in a 24 hour period

  1. Circadian, entrainable oscillation 24-26 hours cycle
  2. Infradian, > 1 Circadian - Menstrual Cycle
  3. Ultradian, < 90 – 120 minutes - This is the sleep cycle 45 min to deep sleep 45 min to light sleep with Blood Circulation, Pulse, Heart Rate; Urination & Bowel Activity; Appetite and Nostril Dilation

 

Sleep Stages

  1. Stage 1: 1-5 Minutes per cycle, easily awakened
  2. Stage 2: Light sleep, 50% of healthy adult sleep - Spindles & k-complexes (necessary for learning); Heart Rate decreases; Body Temperature decreases & Eye Movements Completely STOP
  3. Stage 3: First stage of deep sleep - Blood Pressure Drops; Muscles Relax & Breathing Slows
  4. Stage 4: Deepest, Most Restorative Sleep - More Relaxed; Growth hormones released & 50% Delta Waves


REM Sleep

  • Entered/Exited through Slleep Stage 2:  25% of healthy sleep is REM sleep; 50% of infant sleep is REM sleep; No Voluntary Muscle Movement (muscle atonia); Blood Flow increases by 50%-200%; Sexual arousal increased & Nervous System Increases Activity
  • NO REM Sleep While Sitting Up! So get Gerd Patients to at least sleep at 45 degrees to get


REM cycles throughout the night

  • Increases amount of REM throughout night
  • As REM increases, deep sleep stages decrease
  • Slow Wave sleep first 1/3 of night
  • REM sleep predominates last 1/3 of night
  • After Age 65, REM sleep Decreases


REM Sleep & Neurotransmitters

During REM Sleep:

  • Seratonin (5-HT) and Norepinephrine (NE) are not secreted
  • Dopamine (DA) is activated
  • Acetylcholine (ACh) is activated - Good night’s sleep increases learning

Homeostatic sleep drive (Process S)

During wakefulness a drive for sleep builds up that is discharged primarily during sleep. As sleep drive increases, so do subjective feelings of sleepiness

 

Circadian rhythms (Process C)

Varying strength alerting signal increases over the course of the day and decreases across the night until early morning

 

Sleep Architecture

N1 or Stage 1 (5%) - 5 mins; transitional phase - Low arousal threshold

N2 or Stage 2 (50-55%) - 10-15 mins;

N3 or Stage 3 & 4 (20%) - Lasts 20-40 mins; “delta” “slow-wave sleep”

REM (20%) - Tonic (hypotonic muscles) and Phasic (eye movement) stages

Behavioral Strategies to Reduce Insomnia

  • Exercise: Exercise 20-30 Minutes a Day &  Exercise about 5-6 hours before bedtime
  • Avoid caffeine, nicotine & alcohol
  • Utilize deep breathing & relaxation exercises
  • No TV, No iPad, No iPhone, No i-Screen
  • Control room temperature – less than 70 degrees
  • Sleep until sunlight!
Cognitive Behavioral Therapy for Insomnia (CBT-I)
Sleep diary is an important aspect of therapy and this information will be used throughout
treatment. There is a need to emphasize the importance of daily recording by keeping the sleep diary close to the bed.

SLEEP DIARY

Name: _____________________________

 

Week:_______________  to  ______________                        Example           Fill in the Day of the Week above each column

             (Beginning date)             (Ending date)                                                                                                                                        

                                                                                                                     Mon.   

  1.  I napped from         to         (note times of all naps).

2:00 to

2:45 pm

 

 

 

 

 

 

 

  2.  I took         mg of sleep medication as a sleep aid.

ProSom

1 mg

 

 

 

 

 

 

 

  3.   I took         oz. of alcohol as a sleep aid.

Beer

12 oz.

 

 

 

 

 

 

 

  4.  I went to bed at         o’clock.

10:30

 

 

 

 

 

 

 

  5.  I turned the lights out at         o’clock.

11:15

 

 

 

 

 

 

 

  6.  I plan to awaken at         o’clock.

6:15

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  7.  After turning the lights out, I fell asleep in         minutes.

45

 

 

 

 

 

 

 

  8.  My sleep was interrupted         times (specify number of nighttime awakenings).

3

 

 

 

 

 

 

 

  9.  My sleep was interrupted for         minutes (specify duration of each awakening).

 

20

30

15

 

 

 

 

 

 

 

10.  I woke up at         o’clock (note time of last awakening).

6:15

 

 

 

 

 

 

 

11.  I got out of bed at         o’clock (specify the time).

6:40

 

 

 

 

 

 

 

12.  When I got up this morning I felt         .

   (1 = Exhausted, 2 = Tired, 3 = Average, 4 = Rather Refreshed, 5 = Very Refreshed)

2

 

 

 

 

 

 

 

13.  Overall, my sleep last night was         .

   (1 = Very Restless, 2 = Restless, 3 = Average, 4 = Sound, 5 = Very Sound)

1

 

 

 

 

 

 

 

NOTES:

Sleep Diary Instructions

In order to better understand your sleep problem and to assess your progress during treatment, we’d like you to collect some important information about your sleep habits.

- Before you go to sleep at night, please answer Questions 1 - 6. 

- After you get up in the morning, please answer the remaining questions, Questions 7 - 13.

It is very important that you complete the diary every evening and morning!!!  Please don’t attempt to complete the diary later.  If you have any difficulties completing the diary, please contact your therapist and who will be glad to assist you. 

It’s often difficult to estimate how long you take to fall asleep or how long you’re awake at night.  Keep in mind that we simply want your best estimates. If any unusual events occur on a given night (e.g., emergencies, phone calls) please make a note of it on the diary (at the bottom of the sheet). 

        Below are some guidelines to help you complete the Sleep Diary.

1.  Napping:  Please include all times you slept during the day, even if you didn’t intend to fall asleep.  For example, if you fell asleep for 10 minutes during a movie, please write this down.  Remember to specify a.m. or p.m., or use military time.

2.  Sleep Medication:  Include both prescribed and over-the-counter medications.  Only include medications used as a sleep aid.

3.  Alcohol as a sleep aid:  Only include alcohol that you used as a sleep aid.

4.  Bedtime:  This is the time you physically got into bed, with the intention of going to sleep.  For example, if you went to bed at 10:45 p.m. but turned the lights off to go to sleep at 11:15 p.m., write down 10:45 p.m.

5.  Lights-Out Time:  This is the time you actually turned the lights out to go to sleep.

6.  Time Planned to Awaken:  This is the time you plan to get up the following morning.

7.  Sleep-Onset Latency:  Provide your best estimate of how long it took you to fall asleep after you turned the lights off to go to sleep.

8.  Number of Awakenings:  This is the number of times you remember waking up during the night.

9.  Duration of Awakenings:  Please estimate how many minutes you spent awake for each awakening.  If this proves impossible, then estimate the number of minutes you spent awake for all awakenings combined.  Don’t include your very last awakening in the morning, as this will be logged in number 10.

10.  Morning Awakening:  This is the very last time you woke up in the morning.  If you woke up at 4:00 a.m. and never went back to sleep, this is the time you write down.  However, if you woke up at 4:00 a.m. but went back to sleep for a brief time (for example, from 5:00 a.m. to 5:15 a.m.), then your last awakening would be 5:15 a.m.

11.  Out-of-Bed Time:  This is the time you actually got out of bed for the day.

12.  Restedness upon Arising:  Rate your restedness using the scale on the diary sheet.

13.  Sleep Quality:  Rate the quality of your sleep using  the scale on the diary sheet.
Document
Sleep Diary Form
Cognitive Behavior Therapy for Insomnia (CBTI)
Behaviors
  • Increase sleep drive
  • Optimize congruency between circadian clock and placement of Sleep opportunity (time in bed)
  • Strengthen the signals from the circadian clock
  • Strengthen the bed as cue for sleep (conditional insomnia)
  • Reduce physiological arousal

Cognitions
  • Reduce sleep effort
  • Reduce cognitive arou
  • Address dysfunctional beliefs about sleep
  • Address obstacles in adherence

Components of Cognitive Behavior Therapy for Insomnia (CBTI)
Educational:
  • Promoting Good Sleep Practices and Accurate Information
Behavioral:
  • Changing Maladaptive Sleep Habits
Cognitive:
  • Practicing Healthy Thinking About Sleep
Medication:
  • Planning a Schedule to Discontinue Sleep

CBTI Overview of Sessions
Session 1: Assessment of Insomnia
Session 2: Psychoeducation, sleep logs, sleep hygiene
Session 3: Stimulus control and Sleep restriction
Session 4: Sleep titration
Session 5: Sleep titration
Session 6: Sleep titration
Session 7: Sleep titration
Session 8: Relapse Prevention
CBTI Educational Components
  • The educational components involves teaching basic sleep hygiene principles.
  • Adherence to good sleep hygiene practices is generally poor among insomniacs
  • Outcome studies show that sleep hygiene education alone is unlikely to be sufficient for chronic insomnia

Sleep Hygiene
  • Consistent bed and wake times Important for entraining circadian rhythms
  • Avoid weekend schedules that differ by more than 1 hour than weekdays
  • Minimize napping - Reduces homeostatic drive available for nighttime sleep - If any, keep under 30 minute
  • Environment keep Light, noise, temperature
  • Role of regular exercise -– Avoid 1-2 hours before bed because of increase in core temperature
  • Avoid looking at the clock - it never helps!
  • Caffeine - Sources (more than just coffee) - Can linger >10 hours in the brain so avoid after lunch
  • Tobacco & other substances
  • Alcohol – often used as a sleep aid - Helps with sleep onset but leads to fragmented sleep
Relaxation Therapies
Reducing Arousal with Relaxation
  • Progressive muscle relaxation
  • Diaphragmatic breathing
  • Autogenic training
  • Hypnosis
  • Imagery
  • Biofeedback - EMG & EEG

Behavioral Components
Insomnia sufferers typically develop strategies for coping with their sleep problem which, in the long run, perpetuate their problem
The Behavioral Component consists of:
  • Stimulus Control
  • Sleep Restriction
There is extensive research support for the effectiveness of these procedures

Stimulus Control Instructions
  • Original formulation based on operant conditioning principles -The bed and bedroom lose their stimulus value as a cue for sleep because of non-sleep activities in bed
  • Classical conditioning formulation takes into consideration the idea of conditioned hyperarousal
  • Overall principles:- The bed is for sleep and sleep is for the bed
  • Avoid sleep-incompatible activities in bed - Ex: TV, reading, paying bills
  • Don’t worry, think, plan, etc. in bed
  • Avoid sleeping outside of bed
  • Maintain a regular sleep schedule and get up at the same time every morning
  • Go to bed only when sleepy
Sleepy means having to almost struggle to stay awake, maybe dozing off
Tired and fatigue reflect low energy level but maybe unable to fall asleep – “Tired but Wired”
Sleep naturally unfolds when we are sleepy
If unable to sleep, get out of bed
  • After about 15-20 minutes, or whenever mental or emotional arousal sets in engage in relaxing activities until ready for sleep
  • Have activities planned in advance - Get back into bed, but repeat as often as necessary
  • Establishing new patterns of conditioning usually takes 3-4 weeks
Sleep Restriction Therapy
  • Based on the principle that people with insomnia often use sleep extension
  • When sleep opportunity exceeds sleep ability, wakefulness is the result - less efficient sleep
  • Restricting time in bed leads to an increase in sleep efficiency by using sleep deprivation as a tool
  • Determine average sleep time with sleep logs (sleep ability)
  • Limit time in bed (TIB) (sleep opportunity) to average sleep time - Start with desired wake time and count backwards - 4-5 hour TIB as a minimum for most people - Plan activities to fill extra time
  • Continue with sleep logs
  • Re-evaluate sleep logs once per week
  • If sleep efficiency >85-90%, increase TIB by 15-30 minutes
  • Otherwise maintain current schedule
  • If sleep efficiency drops below 80% reduce TIB by 15-30 minutes
  • Takes at least 4-6 weeks for most people
Sleep Need Questionnaire
Based on the previous week:
1. Did you feel tired or fatigued during the day or evening?
NEVER (1) __ RARELY (2)___ SOMETIMES (3)___ FREQUENTLY (4)___ ALWAYS (5) ___

2. Were you sleep or drowsy during the day or evening?
NEVER (1) __ RARELY (2)___ SOMETIMES (3)___ FREQUENTLY (4)___ ALWAYS (5) ____

3. Did you take any naps or fall asleep briefly during the day or evening?
NEVER (1) __ RARELY (2)____SOMETIMES (3)____FREQUENTLY (4)___ ALWAYS (5) ____

4. Did you feel you had been getting an adequate amount of sleep?
NEVER (5) __ RARELY (4) ___ SOMETIMES (3)___ FREQUENTLY (2) __  ALWAYS (1) ____

Scoring
To determine the next weeks TIB calculate sleep efficiency
If SE > 85% ‐ modify TIB according the following scores
a) Score 9 or less – No Change in TIB
b) Score 10‐12 – TIB increased by 15 minutes that week
c) Score 13 or more – TIB increased by 30 minutes for that week
If SE < 80% ‐‐ Reduce TIB but only if the score on the Sleep Need Questionnaire is 9 or less
Otherwise do not change TIB
This model can be difficult to follow for some individuals
  • Need to prepare clients for extra sleep deprivation - Extra caution when driving or other potentially dangerous situations
  • May be contraindicated for some (ex: epilepsy)
  • Can coincide with time off during first 1-2 weeks
  • Modafinil 100-200mg at a.m. may be used for extreme daytime sleepiness
  • Assess motivation and potential barriers

Cognitive Component
  • Many insomniacs entertain a variety of dysfunctional cognitions that may exacerbate what might have been a transient sleep problem.
  • The cognitive therapy component is designed to correct unrealistic sleep expectations, revisingfalse attributions about the causes of insomnia, and reappraising perceptions of its consequences on daytime functioning.

Cognitive Factors
  • Faulty Appraisal of transient sleep difficulties is a commontriggering point of chronic insomnia
  • Misattributions of daytime impairments to poor sleep can feed into a self-fulfilling prophecy.
  • Unrealistic Expectations regarding sleep requirements are common.
  • Excessive ruminations, magnification, catastrophizing, overgeneralization, dichotomous thinking, and selective recall contribute to a self-perpetuating insomnia cycle

Approaches
Cognitive Therapy – Identification of Dysfunctional Sleep Thoughts – Changing beliefs and attitudes about sleep
Other Cognitive Approaches
  • Paradoxical Intention
  • Cognitive Control
  • Thought Blocking/Stopping
Role of cognitive arousal in insomnia –Pre-sleep mental activity (“I can’t shut my mind off”)
  • Planning for the next day
  • Worry about being able to sleep
  • Worry about next day consequences of poor sleep

Education about sleep
Role of the 2-process model
Normal variation in sleep need
Age-related changes in sleep
Explanation of sleep hygiene

Paradoxical Intention
In bed comfortable with lights out
Try to keep eyes open “just a little longer”
Congratulate self on staying awake
Don’t try to sleep but let sleep overtake you
Remind self that staying awake is the general idea so being awake is succeeding
Don’t actively prevent sleep; let sleep overtake you

Constructive Worry
Make a list of primary concerns
Make list of “active” efforts to work on concerns listed
  • If new ideas to “work the problem” add to list
  • If no new ideas, focus on rest to resume workon problem tomorrow

Relapse Prevention
(1) Maintain regular sleep and wake times
(2) Do not compensate for sleep loss
(3) If insomnia resumes, immediately return to stimulus control
     a. Don’t compensate for bad night of sleep
     b. Never stay in bed for more than 15 minutes if awake
(4) If insomnia persists for several days, begin sleep restriction therapy
     a. Remember, if not tonight – then tomorrow night
(5) If insomnia continues (2 weeks), make appointment to resume treatment
Note: Training in Cognitive Behavior Treatment for Insomnia (CBTI) can be obtained at: https://deploymentpsych.org/training
Tools for Improving Sleep

Apps


Bed Time Sleep Sounds & Nature: Relaxing White Noise Sound

This provides a solution for good sleep with white noise to play in the background. White noise tracks will block out distractions and other unwanted audio artifacts as well as sooth your allowing you to reach REM sleep and stay there. At: https://itunes.apple.com/us/app/bed-time-sleep-sounds-nature/id913329335?mt=8


CBT-i Coach 

The CPT Coach app is designed to assist both providers and patients participating in Cognitive Processing Therapy. Some of the features include an assessment tool for tracking symptoms and progress, homework and assignments for each therapy session, session reminders and other CPT educational material.This app is to be used with clients who have sleep problems. They can design their own Sleep prescription to improve their sleeping habits. They have a number of tools at their disposal to do this on the app. They also have an extensive learning program and daily reminders to use to help them improve their sleep. Read more about it at: https://itunes.apple.com/us/app/cbt-i-coach/id655918660?mt=8


Digipil: Guided Meditation - Sleep, Relaxtion, Mindfulness

This app will you: Beat Insomnia, Lose Weight, Increase Motivation, Reduce Stress, Gain Confidence, Explore Your Mind, Be More Creative, Get Closure and more

https://itunes.apple.com/us/app/digipill-guided-meditation/id578068250?mt=8

Dream Ez - Unfortunately for many people the nightmares can leave you tired during the day. And feeling sleepy all the time can make it that much harder to recover. Dream EZ is based on the principles of imagery rehearsal therapy (IRT). This therapy can help change nightmares into less disturbing dreams so you can get a better night’s sleep. Imagery Rehearsal Therapy (IRT) is an evidence-based treatment for reducing nightmares. The goal of IRT is to reduce the frequency and intensity of nightmares. By doing so, people also find that their sleep, anxiety, and depression symptoms improve.At: https://itunes.apple.com/us/app/dream-ez/id1096134340?mt=8


Dormio

Sleep, Nap, Slumber and Drift into Deep REM Dreaming with Sleepy, Mellow Natural Sounds. High quality sleep enhancement audios from scientists, sound engineers, therapists, and authors across from the planet. A beautifully crafted audio-visual experience by team of top designers which are tailored to help your mind relax and drift off into deep sleep with a timer so your phone will automatically turn itself off at the right time. Read more about it at: 


iSleep Easy - Meditation for Restful Sleep

Create your own sleep program using a playlist feature which allows you to listen to up to six meditations in one session. Liste voice alone or voice with music or nature sounds, choosing how long the background will continue after the voice guidance stops.At

https://itunes.apple.com/us/app/isleep-easy-meditations-for-restful-sleep/id509260769?mt=8


Sleep Bug Pro: White Noise Soundscapes & Music Box

Contains 24 scenes, 83 different sound affects and more than 300 different sounds to ensure that everyone will find an ambience matching their needs. At: https://itunes.apple.com/us/app/sleep-bug-pro-white-noise-soundscapes-music-box/id470476048?mt=8


TaoMix - Create your own Relaxing Ambience with Nature Sounds

Let yourself be carried away by your own relaxing ambience whicch can evolve randonly and at you own speed. At: https://itunes.apple.com/us/app/taomix-create-your-own-relaxing-ambience-nature-sounds/id660104097?mt=8 


White Noise HB Lite

Provides ambient sounds of the environment to help clients who have problems falling asleep to relax or sleep. Read more about it at:
YouTube Videos

Calming Mindfulness Meditation before Sleeping -Let Go and Sleep Well from Jason Stephenson At: https://www.youtube.com/watch?v=DFEnruF-dts


Reprogram Mind Before You Sleep Guide Meditation, Relax and Change Your Thinking Before Sleeping  from Jason Stephenson


Guided Meditation for Sleep, Poaricw Miracles - Spoken Meditation + Music from Jason Stephenson

Guided Sleep Meditation for Insomnia (Sleep, Relaxation, Calm your Mind) from Lina Grace

Sleep Meditation for Deep Relaxation and Anxiety Relief from Medication Vacation
Podcasts

Get to sleep fast with Tracks to Relax Sleep Meditations by Tracks to Relax

Everyone has had trouble falling asleep occasionally. We spend so much time stressed out as we constantly try to juggle and balance careers, relationships and health. A good night’s sleep can give us the energy and mental clarity we need to get what we want out of life but turning off your mind just because it’s bedtime can be challenging. For many people, bedtime has become a time to worry, stress or toss and turn as they try harder and harder to fall asleep. Tracks to Relax can provide the sleep help you need by turning bedtime into relaxing “me time”. Our powerful Sleep Guided Meditations are designed to relax both mind and body quickly at bedtime. The time between when we go to bed and actually fall asleep is a great time to undo some of the knots in our mental rope and feed our subconscious mind with positive information, ideas, visualizations and suggestions. Our audio sessions will lift you up, make you feel empowered and even help you make self-improvements, all while you relax completely and drift off into a wonderful sleep. We have audio sessions for Getting Back To Sleep - Falling asleep quickly and easily - Breaking bad habits - Boosting Self Confidence - Stress relief - Making positive changes - Reduce worrying - Remove emotional blocks - Managing blood pressure -Lose weight - Positive Healing -Chakra balancing - Getting unstuck - Increase Motivation - Goal setting - Deep relaxation - Fun relaxing fantasies - Law of attraction - Increasing self-esteem - Positive affirmations - Progressive muscle relaxation - Positive thinking - Reduce Food Cravings - Improve Relationships - Stop Insomnia and more! 

On iTunes at: https://itunes.apple.com/us/podcast/get-to-sleep-fast-with-tracks-to-relax-sleep-meditations/id834515877?mt=2

UCLA's MARC Guide Meditation: Body Scan for Sleep
Sleep Disturbance Assessments

Berlin Questionnaire (for Sleep Apnea) Available at:


Insomnia Severity Index Available at:

Morningness-Eveningness Questionnaire (MEQ) Available at: 

PROMIS Short Form v1.0 – Sleep Disturbance 8a Available at:

Restless Legs Syndrome Ratin Scale Available at: http://www.bandolier.org.uk/booth/RLS/RLSratingscale.pdf

Stop Bang Questionnaire Available at:
Websites on Sleeping Disorders




CDC Sleep and Sleep Disorder Resources - At: https://www.cdc.gov/sleep/resources.html

American Psychiatric Association - What are Sleep Disorders? At: https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders

Sleepopolis: All about anxiety: Why is it preventing you from sleeping? at: https://sleepopolis.com/education/anxiety-preventing-sleep/

Everything you Need to Know about Sleep Disorders at: https://www.terrycralle.com/sleep-disorders/