#103 - How to Motivate and Change Sleep Behaviours
The simplest way to describe sleep therapy is discovering the main cause of the sleep problems - and then matching that cause with a scientifically-proven treatment.
For example, for 15 years we have been researching teenagers’ sleep - resulting in over 75 scientific studies.
We’ve learned that teen sleep problems are not caused by technology (for example, see Blog #65).
It’s their underlying biology that’s askew - And thus we match this biological cause with a treatment that has been shown to work (see here for an example).
But sometimes, people need additional help to improve sleep …
Reflections
This week marks my final month supervising clinical psychology students - who are learning to do what I do.
And I’ve been really proud of ‘Benni’ and ‘Alex’ who have shown me that they’ve learned certain clients need more that sleep therapy.
In this week’s supervision session, they ran through their current caseload of clients - one by one.
And one of their clients wasn’t improving.
The diagnosis of the sleep problem was very clear. And both Benni and Alex knew the sleep treatment to provide - one that we have developed and tested (and retested) over the past 15 years.
Not only did they identify that this was not a simple case of matching the treatment to the problem - but they identified what was getting in the way.
And one of the most common factors that gets in the way of a successful sleep treatment outcome - is motivation.
The Wheels of Motivation
Motivation might be one word, but it is not one ‘thing’.
Motivation is made up of many different components. But to make it slightly easier to understand - we’re going to focus on Intrinsic Motivation.
As opposed to Extrinsic Motivation (ie, motivating oneself to make a change in order to receive an external reward), Intrinsic Motivation does not rely rewards.
Intrinsic Motivation ranges from people who will definitely not change because they do not believe they have a reason to change - through to people who are so ready to change that they begin experimenting themselves before you even work with them.
Most people who seek to improve their sleep lie in the middle - between “believing they do not having a sleep problem” to “I am ready to do whatever it takes to improve my sleep.”
And within these extremes there are shades of grey.
The 1st task of the motivation process is to correctly identify what ‘Stage of Change’ the client is currently at. Get this wrong, and their motivation can decrease when you attempt to boost it.
The 2nd task is to help the client move from their current level of motivation - to a higher one. This means:
matching the right techniques
asking the right questions
not pushing the client too hard, but
motivating them at the right points of the conversation.
These tasks are crucial, yet can be performed within a single session with a client - and in some cases, the client can increase their motivation by the end of the session.
The Pain of Sleep Therapy
Motivational Interviewing was originally used to help people change specific behaviours linked to using drugs or drinking alcohol, and then moved onto people struggling with gambling behaviours.
But many researchers noted Motivational Interviewing could be used for virtually any behaviour that needed changing.
It was therefore used to help people:
use more sunscreen to reduce the risk of skin cancer
increase people’s motivation to exercise
reduce people’s intake of crappy foods
… And a whole bunch more. After a while, there were researchers who thought it could be useful for helping people with their sleep therapy.
The first group were adults with Obstructive Sleep Apnea (ie, a condition where snoring leads to choking which leads to waking up from sleep). The best therapy for Sleep Apnea is wearing a vacuum hose on blow (it’s a long story … ).
As you can imagine, this can be an unpleasant form of therapy - and many clients needed that extra bit of motivation to wear this vacuum cleaner on the face all night.
Later on, it was recognised that teenagers had issues with their sleep - specifically difficulty waking in the morning. A great therapy for this was to wake up earlier to help regularise their sleep.
But teenagers hate waking up earlier - so Motivational Interviewing was again called in to assist with a painful sleep therapy.
And this was researched by us ….
Since then, we’ve noticed other types of clients who made need Motivational Interviewing on top of sleep therapy - for instance, mums who know sleep training can help their infant sleep - but listening to their child cry is too painful for them.
Or adults undergoing CBT for Insomnia, but who struggle with some of the classic behavioural therapies.
Conclusions?
We’re at the stage where we can identify the main cause of sleep problems for various age groups - and matching them with the right sleep treatment.
This works most of the time.
But sometimes you have to call in the cavalry - and add extra therapies. For many years, Motivational Interviewing has been a terrific add-on therapy for a whole range of problems.
And our group has been researching its use for sleep problems (Cain et al., 2011; Gradisar et al., 2014; Bonnar et al., 2015; Micic et al., 2018). Furthermore, we’ve been teaching clinical postgraduate psychology students how to do this.
Now we’re making this training available for you - with our online course ‘Motivational Interviewing for Sleep Problems’ - due for release in Early 2022.
Learn more here - and as always, we’re happy to field your questions before you go ahead.
Prof MG