Tips for easing into sleep
Source – June Reflexions 2018 – Author – Dr Peter Mackereth PhD & Paula Maycock
Reflexions is the AoR members quarterly magazine letting you discover the latest reflexology insights. Written by Reflexologists, for Reflexologists.
In our June 2018 Edition we discussed HypnoReflexology and discussed the range of sleep related disorders, including insomnia, sleep walking, snoring and breathing disorders. Here we share with you one article from this popular magazine. Want more? Join today and access this whole edition of Reflexions as well as a library of previous editions of this highly sought after magazine.
We will focus on insomnia, which varies in presentation from being unable to sleep at all, to difficulties getting to sleep, and waking up numerous times. It is estimated that between 30-40% of the population have symptoms of consistent sleep disruptions, with over 10% having resultant functional daytime problems. Typically, insomnia brings with it fatigue, lack of energy, irritability, reduced work performance, difficulty concentrating, and strain on relationships. Many people live with insomnia without reporting it to their GP, with older people, divorcees, the widowed, those who are obese and snorers being at greatest risk.
It is important to also be aware of co-morbidities, with memory loss and dementia being associated with evening agitation, called ‘sun downing’, and insomnia.
Sleep quality and duration can also be affected by alcohol, smoking, and caffeine. We know that drinking alcohol in the evening, although relaxing at first, will later disrupt and create fitful sleep’. Toxic chemicals found in cigarette smoke combined with nicotine, an addictive stimulant, are often the cause of chronic insomnia in smokers. Going smoke-free is associated with improvements in sleep and fatigue.
It is important to remember that insomnia can be transient, lasting less than two weeks, and may be associated with temporary stressors, such as a change of job or home.
Insomnia can be intermittent, with repetitive episodes – again, these may have known triggers. Those clients presenting with chronic insomnia will have a history of six months or longer of interrupted or little sleep.
Sleep and Reflexology
We both work in cancer care and with other long-term conditions, such as multiple sclerosis. Sleep disorders are common amongst our patients (and carers). As trained hypnotherapists, we inevitably used the inherent skills and knowledge to inform our reflexology practice, for example by recognising the therapeutic potential of language, and empowering patients by teaching reflexology focussed self-soothing techniques. As a reflexologist yourself, we are sure that many of your clients will have reported sleeping heavily post-treatment, even sharing their curious dreams. Indeed, a review of 18 reflexology studies concluded that reflexology could promote quality and depth of sleep3. In subsequent controlled studies researchers have also reported improvements in sleep in the intervention groups. Our goal in HypnoReflexology© is to augment and build on best reflexology practices, particularly the use of rhythmic, repetitive and slow movements. To summarise the therapeutic processes described here, we include our SYMPTOM Model6
The Principles of HypnoReflexology©
In gathering a sleep history, it is helpful for the therapist to determine the patient’s sleep habits, commonly referred to as ‘sleep hygiene’. Asking the following questions can be a useful starting and review point for a series of sessions:
- Before bedtime, what do you do to prepare for sleep?
- How is your bedroom set up for a comfy, refreshing sleep?
- Are there any helpful routines, advice or ways of easing into sleep that you have heard of,
and are interested in exploring? - Would you be interested in a combination of techniques combined with reflexology to promote sleep?
These questions are deliberately positive and leading, and here you can drop into the conversation that there is a growing body of evidence for reflexology assisting with improved quality of sleep. Be careful to avoid the word ‘longer’ in terms of hours slept, clients can become focussed on the duration of sleep rather than its depth and quality.
How is your bedroom set up for a comfy, refreshing sleep?
A key principle of HypnoReflexology© is to use placebo rich language. By saying things such as “my other patients regularly talk about sleeping heavily and having dreams after reflexology – you might notice this too”, this can increase an expectation that reflexology will help. Saying you might be restless and emotional after reflexology would be ‘nocebo’ talk and be the opposite of what we are aiming to suggest. The more anxious you are, the more you are likely to fear the worst; the more comfortable and calm you feel, the more optimistic and open you will become to the treatment’s benefits. Be careful about overdoing the history taking; we all know that as reflexologists, our clients often disclose things and can think more clearly once they start receiving the hands-on work. Paula and I have had our best ideas for resolving challenges and having creative thoughts whilst receiving reflexology ourselves!
Another key principle of HypnoReflexology© is to support clients to drift into a state where they feel deeply comfortable and calm. We would argue that the reflexology package of care can act like an induction technique in hypnotherapy.
As reflexologists, you may have noticed as the session progresses that your client’s eyelids become heavy, there is moisture around the eyes, exhalations lengthen, accompanied by yawning, salivation and even stomach gurgling – all these would suggest a profound relaxation response. In this state, some agreed imagery, goals and suggestions for change and support can be included (see Case Study). Using invitational language and choices is essential to maximising the reflexology session and assisting to ease a symptom or concern.
Case Study
Sophie, with a six-year-old daughter, had received a recent diagnosis of treatable breast cancer and was distraught because of fatigue linked to insomnia. In exploring her sleep hygiene, Sophie talked about her recent habit of reading emails and playing computer games in bed, whilst drinking a large glass of red wine.
Sophie usually drifted off to sleep around 4am. Exhausted and irritable, the school run was impossible. During the ‘heavenly’ reflexology, Sophie stated, ‘what the hell am I doing glued to the blue screen and not spending time with my daughter?’ Discussion ensued about suggestion to manage intrusive thoughts – the three Steps to Ease into Sleep (page 21) was offered. She used this for the first week with good effect, and then moved to simply using an ‘anchor’ to recall the ‘heavenly’ reflexology session – which was using her thumb to work the solar plexus areas on the hands. She also came up with the idea of having a bath, sipping herbal tea, rather than the red wine. Sophie followed this by rereading her favourite Bronte novels rather than computer games. At the sixth session review, Sophie reported being asleep by midnight, being more energised, happy with her sleep hygiene routine, saying it mirrored that of her daughter’s ‘bath and book time’, and enjoyed chatting to other parents at the school gates.
HypnoReflexology© Homework
We suggest the following exercise to ‘park’ worries and concerns and then ‘ease into sleep’; this exercise speaks to the unconscious, which can interrupt sleep during the night to address worries. Writing down these issues/concerns reassures the unconscious that we are not ignoring them. Cortisol rises on early awakening – often this is to prepare the body and mind for the immediate challenges and resurfacing worries that need to be faced or ruminated upon’. A constant high level of cortisol is difficult to sustain; fatigue is exacerbated, immunity is compromised and normal recuperation of the body (and mind) hampered. The ability to calmly explore issues and concerns is diminished in the presence of stress hormones. When cortisol peaks and then starts to reduce, the body can then shift into recovering and revitalisation as homeostatic balance returns.
Our second step, progressive muscle relaxation (PMR) has an evidence base for reducing cortisol, as does reflexology.
The third step is then to suggest the patient sinks back into a soft pillow recalling a reflexology treatment for easing into sleep; this might be prompted by use of a reflex point on the hand (an anchor). It may also be useful to add that there is evidence that being grateful for having a therapeutic intervention or process9 at hand to practice as a routine each night, such as this three-step intervention, can be of value itself to the quality of a person’s sleep.
S
Symptom definition and causation
Review current sleep hygiene and pattern and identify any contributing factors
e.g. smoking, alcohol use.
Y
Your patient’s experience of the symptom
Review current sleep hygiene and pattern and identify any contributing factors
e.g. smoking, alcohol use.
M
Medical management/assessment
Review medical supervision/ referral/ medication. If there are any comorbidities/
underlying medical issues, encourage the patient to seek medical advice.
P
Purpose of you providing HypnoReflexology©
Identify and practise reflexology adaptations, strategies/suggestions to assist with sleep
quality. Work with quality rather than quantity expectations.
T
Technique/treatment delivery/route.
Minimum of six sessions of reflexology combined with HypnoReflexology©
interventions e.g. combining PMR and Reflex points as induction prior to sleep,
or recalling the reflexology session using an ‘anchor’.
O
Options / advice.
HypnoReflexology© homework.
Identify top tips for Sleep Hygiene e.g. cool comfy room, no distracting technology
in the bedroom, a bath before bed, 20 minutes of moderate exercise every day.
M
Monitor/maintain symptom control
Weekly Sleep Diary e.g. record interventions used and any dreaming.
Visual Analogue Scale 0-10 on the quality of sleep – avoid setting goals for hours slept.
Review of Sleep Hygiene and HypnoReflexology© strategies.
Three Steps to Ease into Sleep
- Write down key worries. Now rate them / reorder from high to low and put the list by the bed, saying to yourself; I have written these down – they will be there in the morning to review again.
- Now move into a relaxation technique – we would suggest PMR; this releases tension through tightening various muscle groups around your body, for example, raise and then drop the shoulders, tighten the arms and let go, make fists and then soften the hands. As you tighten an area, take a comfy breath in and then release the breath when letting go, making the exhalations longer than the inhalations.
- Finally, now become aware of the blanket/ duvet resting comfortingly on your body and recall the presence of your therapist holding your feet. Remember feeling so at ease that you cannot help but smile like a mediating Buddha or a baby sleeping. So, notice when you smile your nostrils open and breath flows easily, and as you breathe out your body softens and tension melts. If you wake, repeat this process knowing that each and every time you move into relaxation, your cortisol levels will drop and your body and mind will enter a recovery phase, building your inner resilience.
Notice the language we have used throughout this article; rather than saying insomnia, we say ‘ease’ or ‘promote’ sleep. In HypnoReflexology©, having choices is key, so inviting the client to use one or more interventions and combining approaches has a synergistic effect.
We will leave you with a suggestion; after reading this article, select a strategy or pursue a curious point through further reading or discussion with a colleague, and contemplate how you might include one or more interventions with your next client seeking a better night’s sleep.
Dr Peter Mackereth PhD & Paula Maycock
Peter Mackereth & Paula Maycock offer training in HypnoReflexology© to AoR members, supported by the online recording. For information on guided imagery promoting relaxation and easing symptoms, see our new book Aromatherapy, Massage and Relaxation in Cancer Care: An Integrative Resource for Practitioners by Peter Mackereth & Ann Carter.
