Development of the Sleep Well Program started in 2006. It is based on the SSLD (Strategies and Skills Learning and Development) System created by Professor Ka Tat Tsang at the University of Toronto. The Sleep Well program was initially designed as an 8-week group intervention, with a follow-up booster session. The program has been piloted in Toronto with very encouraging results. The application was later taken to Hong Kong, with continuous development and refinement. Taking advantage of client feedback and practice experience, the program was fully revised in 2012 to Sleep Well 2.0. Like most SSLD programs, ongoing R&D will be conducted.
Our sleep pattern is affected by processes in all the six domains:
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Environmental
- Chemical substance affecting sleep: stimulant (caffeine), medication, hypnotic substance in food (e.g., tryptophan)
- Physical source of discomfort (hard rigid mattress),
- Distraction (noise, light, snoring partner),
- Social reality: Interpersonal relationships, work related demands (e.g., shift duty, overtime)
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Biological program
- Neurophysiology
- Stages of sleep
- Medical condition, pain, postpartum hormonal changes
- Genetic pre-disposition
- Bio-rhythm
- Muscle tension
- Shallow breathing
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Motivation
- Achievement drive (e.g., need high energy and performance)
- Mastery and control over self, or social and interpersonal reality (e.g., relationships)
- Unmet needs (e.g., security, sex, intimacy)
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Cognitive
- Negative automatic thoughts, negative sleep thoughts
- Misinformation and rigid expectation increasing anxiety and sense of failure/defeat(e.g., 8 hours myth)
- Self blaming, self degradation: Other people can do it, only I can't
- Negative extension, exaggeration: If I can't sleep, my health will deteriorate
- Cannot make sense: Why can't I sleep? Have I done something wrong? What's wrong with me?
- Absolute, all-or-nothing dichotomous thinking
- Defeatism
- Religion, faith, philosophy of life
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Emotional
- Fear
- Anxiety
- Guilt, shame
- Anger, frustration, agitation
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Behaviour
- Fighting, forcing
- Agonizing
- Multiple attempts at ineffective strategies (restless rolling and tossing)
- The program is not only dealing with a symptom such as insomnia, but aims at supporting clients to learn new ways to deal with sleep-related issues as an important aspect of their lives. The ultimate objective is not symptom removal, but improved capacity for meeting one’s needs and goals. ased on SSLD principles, the intervention program will address factors and processes affecting sleep quality of the participants in all the domains of environment (social and physical), body and biological program, motivation, cognition, affect and emotion, and behabior.
- Based on SSLD principles, the intervention program will address how sleep-related issues affect people’s lives in all the six domains of our life-world: environment (social and physical), body and biology, motivation, cognition, affect and emotion, and behavior. At the same time, factors and processes in these six domains will be examined with regard to how they affect and condition the sleep-related issues.Multiple contingency thinking: Not a standard method for everyone; each person will develop his or her own strategy to sleep well.
- The Sleep Well program is a need-based rather than problem-based intervention. The focus is on understanding the unmet needs behind the presenting issue, and not simply symptom management. It is recognized that current thinking and behaviors that interferes with quality sleep are motivated; and it is important to recognize those needs/drives; and to address them within the parameters of the program.
- SSLD analysis pays attention to what clients are doing with the sleep-related issues as an aspect of their lives, and how their needs and goals are being met and frustrated. Based on this analysis, members will explore new strategies and skills that will allow them to address their needs and goals more effectively, including how they deal with their SRIs.
- Though designed as a group program, we do not believe that a standard method will automatically work for everyone. The Sleep Well program is designed with built-in flexibility so that each participant can develop his or her own strategies and skills to sleep and live better. Many of the program (e.g., learning new ways to deal with life demands and stress, improving relationships, relaxation and breathing, how to modify cognitive processes) are built to address individual differences. Participants are going to learn and develop new strategies that will help to create more favourable conditions for sleeping well.
- The program can also be adopted easily for individual intervention.
Self-efficacy is a key concept in social cognitive theory, one of the conceptual building blocks of SSLD. Self efficacy is understood as beliefs in one's capability to organize and execute the courses of action required to manage prospective situations (Bandura, 1977b, p. 2). In everyday language, we may be referring to similar concepts such as self-confidence and self-sufficiency. The major idea is that we believe in our ability to manage situations in life. This entails the ability to accurate assess the situation, establishing a sense of purpose and direction, developing appropriate strategies and mastering relevant skills to achieve our goals in these situations.
Self Efficacy
- Belief in one's ability to deal effectively with situations in life effectively - in that we are able to attain our desired outcome or goals in those situations.
- Confidence or proficiency in the necessary interpersonal or social skills (specific courses of action) and knowledge of how they can be organized (strategies) to deal with the situation effectively.
Weekly meetings with one segment focusing on Body Work and sharing and support, the other focusing on psychosocial strategies and skills:
Advantage of Group Program: Experiential Sharing and Mutual Support
- Participants have diverse experience of difficulties with sleepBody awareness
- Sharing reduces stress related to sense of isolation or particularization – I am not alone
- Opens up alternative perspectives
- Sharing will facilitate information sharing, skills and strategies learning, and emotional support
Program components target the six domains of the Life-world, according to SSLD principles:
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Body Work
- Body awareness
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Systematic Relaxation
- Rhythmic breathing
- Relaxation of voluntary muscles
- Progressive relaxation combining breathing and muscular relaxation
- Stretching and relaxation: combining Yoga, Feldenkrais, and movement procedures
- Physical activities and sleep.
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Cognitive Domain
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Helpful perspective on sleep
- Multiple domains
- Individual difference
- Self-efficacy and positive expectancy: I can learn to do something to make a difference
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Information on sleep and misinformation
- Stages of sleep
- 8 hour myth
- Factors affecting sleep quality
- Sleep efficiency
- Medication
- Food and diet
- Sleep and napping
- Review life circumstances with reference to sleep
- Addressing negative ideas regarding sleep
- Positive reframing
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Helpful perspective on sleep
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Emotional Domain
- Awareness of emotions associated with sleep (e.g., over-arousal, anger, frustration, sadness, depression, etc.)
- Effective emotional management: Connection, ownership, expression, ventilation and equilibrium
- Humor and emotion
- Quest for pleasure
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Motivation Domain
- Motivation for wakefulness (e.g., wish to speak to family member who comes home late, fear and vulnerability)
- Unmet or unfulfilled needs
- Motivation for change
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Behavioral Domain
- Self monitoring: Sleep Diary, recording and charting
- Incremental take-home tasks (PFA, preparing for future action)
- Improved health practice: Physical exercises, diet, daily routines
- Specific strategies (e.g., Stress management, relaxation, establishing emotional and social support, stimulus control, reconstructing the sleeping environment, cultivating sleep promoting habits, etc.)
- Forming buddy system for reminder, encouragement, and support
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Environment
- Re-designed physical environment supportive of personal sleep habits
- Improved emotional and interpersonal environment with reduced stress and enhanced psychosocial support
- Increased sense of mastery over one’s environment, and life in general