Sleep Coaching (®Klösch & Holzinger) Outlined
Part 2: Sleep Education
In the first part of this sleep coaching article, I described the frame of our methodology and how a Gestalt approach can allow us to integrate all elements needed to give back to sleep its duly place in our lives. The field, which is inherent to who we are and how we feel, is based on the long History of humankind and especially of the History we retained in the location we were born and live in. We interact daily with the field, grow within it and often define ourselves in accordance to it. We also developed our sleeping habits, whether healthy or not, in the interaction with our field. In this part we will now start to going into the core of sleep, as I would like to address the first element of sleep coaching which is sleep education. Knowing all the processes happening while we sleep will not only help us to answer the crucial question “why do we sleep”, it will also make us aware of a part of ourselves that we usually neglect.
Why do we sleep?
First, we sleep to regulate energy: we eat food during the day and “convert” it into the energy that we consume during the day. In the evening we rest and use very little energy while sleeping, thus, we spare energy. The second important task that our sleep does for us is regeneration. It is commonly known, that when are sick, we need to sleep and rest to get better. Not only did we learn this from our parents, also our bodies naturally signal it to us: when we are sick, we feel tired. What is it that leads to the regenerative effect of sleep? Well, during the deep sleep phases, our body releases growth hormones. In children this hormone is primarily used to grow, and it really is a fact that children grow during deep sleep. The growth hormones are also released in adults and cause cell regeneration, which contributes to recovery. Another effect of deep sleep is the strengthening of our immune system, which recovers during the night and at the same time can achieve its task, fighting infections, without being disturbed.
So: We sleep to save energy, to strengthen our immune system, to grow and to regenerate.
However, that is not all and does not explain all of the many negative consequences of unhealthy sleep. At this point, I would like to dedicate myself to our brain, because during sleep it may perform one of the most fascinating processes of the night, at least from a psychological point of view.
This little miracle takes place during REM sleep, the famous sleep phase during which our closed eyes move under the lids, the time of the night when we experience the most complex dreams. Our brain now goes through the entire day and recalls all of the experiences we have made. Until that moment, those memories were stored in our short-term memory. During REM sleep, all events that seem important to us are being transferred into long-term memory by forming new synaptic connections. What seems unimportant to us is simply deleted. Who needs to remember when and how often we took a sip of water? Such information is not transferred to the long-term memory, it just gets deleted, unless this detail has some deeper meaning for the sleeper.
Think of it as a computer hard drive being cleaned to make room for new files. When our brain has done this job and we wake up, our short-term memory is free to store new experiences for a short time, until the next night, or more precisely: until the next REM sleep.
During this process of saving, images flicker in front of our inner eye: those images are the ones being expressed in our dreams. As a result, most of our dreams consist of day residues, often expressed through cryptic images, which is why we do not always recognize where they came from. This figurative way of expressing memories in our dreams leads to the assumption that our memory also stores abstract facts in a figurative form. You can imagine it like a painting that conveys countless impressions and statements. Once our brain has stored what it will keep from the day in our long-term memory, we can go back to it for a long time, look at the paintings and “translate” the images back into facts, so to speak.
Once we are aware about this function of sleep, it is hardly surprising that people who suffer from unhealthy sleep often appear confused, cannot concentrate well and can also have memory gaps.
To summarize again, the answer to the question ‘Why do we sleep?’ is as follows:
We sleep to save energy, to strengthen our immune system, to grow, to regenerate and to consolidate our memory.
One thing is still missing here: we also sleep to detoxify our entire body.
The liver works at full speed during sleep: it filters out all toxins that we have accumulated in our body during the day. A relatively new finding from sleep research is particularly interesting to corroborate the detoxication effect of sleep. The study addresses our brain. It seems like noradrenaline is used while we sleep to create more space between the nerve cells of the brain, in order for our cerebral fluid to flow through better. Basically: our brain is being “rinsed”! Among other pollutants, the protein amyloid beta is removed, the protein that is presumably partly responsible for the development of dementia or Alzheimer’s disease.
Now I have listed the most important functions of sleep, we know that we sleep to save energy, to strengthen our immune system, to grow, to regenerate, to consolidate our memory and to filter toxins from our body and our brain.
It is no longer surprising why bad sleep is called “unhealthy sleep”!
In the second part of sleep education I would like to talk about our rhythm of life and our sleep architecture.
Let’s just start with a day: it consists of 24 hours. Our life is adapted to these 24 hours. We have a timer in us, or let us rather say a clock, an internal clock called circadian rhythm. This internal clock determines when we get hungry, when we can concentrate best and when we get tired. This inner clock is significantly influenced by sunlight (I will detail this later on). Let’s stay a while longer in this 24-hour long day, which is divided into smaller units, the so-called BRACs, Basic Rest-Activity Cycles. These BRAC phases were first hypothesized by Nathaniel Kleitmann in the 1950s. Each BRAC is on average 90 minutes long, but this can vary from person to person. Even if a BRAC is longer or shorter for some of us, for example 80 or 120 minutes, for the sake of simplicity, I will always refer to 90 minutes in the following.
These 90 minutes of BRAC can also be felt during the day, but I would like to focus first on its effects on sleep. The night begins with the setting of the sun: it’s getting dark. Until then, the sunlight prevented our hormone melatonin from being released: it will now flood our bodies and make us tired. This phenomenon occurs earlier for some people, so-called morning people, i.e. larks, some others only feel the effect of darkness later, then we speak of night people, i.e. so-called owls. This is where it shows that people are of different chronotypes.
Caution: The release of melatonin is not only prevented by sunlight, but by any light that contains high levels of blue light, which is also the case with screens and LED lamps. This prevents the natural effect of the nighttime darkness.
Melatonin is generally referred to as the sleep hormone; it is also available in the form of capsules, which are considered a natural sleep aid, as they do not disrupt the sleep cycle and are containing what also naturally is produced in our bodies.
The BRAC cycles determine the sleep rhythm, or the sleep cycle, which is repeated every 90 minutes. A cycle begins with a light sleep phase, in the first cycle of the night with the sleep onset. Then we sink deeper into sleep, until we reach the deep sleep phases. Gradually we go back up the scale from the deep sleep phase, until we reach the REM sleep phase. At the end of the first BRAC of the night, we experience our first REM sleep phase, i.e. a dream phase, at the end of which we wake up briefly in so-called micro-awakening, which we usually do not notice. Then the second BRAC of the night begins and we gradually sink back into deep sleep.
We experience 4 to 5 cycles within one night, but they differ from each other.
Only during the first two sleep cycles do we experience N4 deep sleep, in the second half of the night we only sink until the N3 deep sleep. In return, however, the REM sleep phase becomes longer and longer during the night and lasts about 30 minutes during the last sleep cycle. This explains why we dream more and experience more complex dreams shortly before awakening, and less during the first half of the night.
Why is it important to know and understand this cycle? For many reasons, but I would like to take one of them as an example.
There are some people who are consciously aware of these micro-awakenings that take place between the BRACs and find it worrying. However, if they know that everyone is experiencing these micro-awakenings, then they will no longer find it unusual and worrying. If you worry less about it, you will experience less negative stress and fall back asleep more easily.
Stress, the underestimated enemy
Now, I would like to briefly take up the topic of stress. By doing so, we address an essential sleep thief. Fears and worries cause negative stress, so-called distress. On the other hand, positive stress, known as eustress, lets us live through the day with great dynamism and it can even promote sleep, as we are usually exhausted at the end of an active day and need sleep to regenerate: the so-called sleep pressure (the need/desire for sleep) increases.
What happens in our bodies when we experience negative stress, distress? To answer this question, we have to go very far back in time, namely to the origins of mankind. Back then, there were many life-threatening situations that required quick reactions. In the face of danger, such as an attack of the infamous saber-toothed tiger (yes, 300000 years ago, our ancestors met them!), a person’s body released the stress hormones cortisol and adrenaline, which make us ready to fight or flee by activating the sympathetic nervous system, raising blood sugar levels, stimulating our circulation and speeding up our heartbeat. All of this happens at lightning speed, followed by an active reaction, i.e. a fight, a flight or something similar.
Through this physical reaction of the prehistoric humans, fighting or fleeing, this alarm condition of the body was reduced back to normal and the blood sugar was used up. Nowadays, our bodies react to danger, anger, pain or fear in the same way as the people from the Paleolithic era once did. The problem with this is that most of the time we cannot react physically and the substances released are therefore not broken down in our bodies. What remains is what we call negative stress, i.e. distress.
For example, if we had an argument on the phone at work, our body is on the alert, but we have to sit still and often not even raise our voices. This suppression of the natural primal reactions means that we often carry with us the stress that has arisen, it even builds up further, as if caught in a vicious circle. Major symptoms of stress include difficulty falling asleep or staying asleep. Our thoughts, controlled by stress hormones, begin to circle, our sleep becomes restless: this creates even more stress.
Life in the modern world is overflowing with stress factors. The world of work itself, but also the possible existential fears caused by unemployment, precarious working conditions, financial worries, fears for the future, etc. In addition, there are interpersonal relationships, which are often characterized by restraints, “acceptable” behavior, even during discussions. The Coronavirus and the measures to prevent its spread add to the already long list of stress factors. In our society, there is hardly any room for stress relief, less than ever in the current crisis. Many of us end up using the car for releasing stress though aggressivity, with disastrous consequences on the accident statistics. For some of us, staying calm through the whole day feels like creating a piece of art while fighting the deep desire to just smack it against the wall.
Those who suffer from stress can expect serious health consequences, which are exacerbated by the stress-related sleep disorders. Cardiovascular disorders and diabetes are just the best-known examples. From the point of view of a sleep coach, reducing stress is an essential factor in finding the way back to healthy sleep. Knowing about distress is therefore not only an important part of sleep education, but the main reason why one of the four pillars of the sleep coaching(®Klösch & Holzinger) method is hypnosis, meditation and relaxation techniques.
The knowledge of the processes that happen in us before and during sleep not only helps us to recognize the importance of sleep and therefore to devote the necessary time and attention to it, it also helps us to uncover and illuminate some backgrounds of sleep disorders.
We now know, for example, that if we expose ourselves to the light of the sun or a high proportion of blue light, the production of melatonin is suppressed. A long walk in the sun keeps us awake: someone who wants to sleep after a night shift should not expose himself to the light of the morning hours.
We also now know that micro-awakening is normal and part of the sleep cycle. If you wake up briefly, you can go back to sleep with confidence, there is nothing to worry about here.
When does sleep start to be unhealthy?
This might not be a question as easy to answer as it seems at first glance. Assessing our own sleep quality is not always easy. Many people claim to have difficulties falling asleep though in reality they fall asleep after only 15 minutes in bed, which is still very close to the norm. People who consciously experience their micro-awakenings also often claim to have unhealthy sleep, while actually there is nothing wrong with it. Let us start with the sleeping hours, that are to be found in most journals and articles about sleep: we need about 7–8 hours of sleep per night. This number is not chiseled into gold, though it is quite accurate, if we take it as an average. It varies a lot from one person to another. While some people might feel entirely rested after only 6 hours of sleep, other will need nearly 10 hours to get to the same result. Some studies seem to show that people who sleep a little more than 7 hours per night are the one having the highest life expectancy, I would assume though, that this number came to stand only because 7 hours of sleep is what a majority of people need.
You also have a big difference between children and adults, children need way more sleep, infants even need about 14 hours of sleep. They still have polyphasic sleep though, meaning, that they do not get the whole 14 hours at a time, they sleep several times a day. Elderly people need a little less sleep, about half an hour less and often they tend to experience more biphasic sleep.
What can be retained is that sleep is unhealthy, or you suffer from sleep deprivation, if you do not feel rested after waking or if you experience day time sleepiness.
How does sleep come about?
We now come to our next topic of sleep education and introduce this with a question: How does sleep come about? Only if we know how sleep is created can we take a further step into finding out what promotes sleep.
Sleep begins with sleep pressure, or the need to sleep, basically: tiredness.
Physical tiredness results from physically demanding activities such as hard work or sports. We now know that the body regenerates and gets rid of toxins in the deep sleep phase, so it is easy to come to the right conclusion: physical fatigue promotes deep sleep.
On the other hand: a person who has experienced a lot of new things, or has exposed himself to new impressions, has more elements that have to be transferred to long-term memory. The conclusion from this is logically: many new experiences promote REM sleep.
It is of course not that simple to promote sleep, but these are important factors. If we now become aware of what we have done and experienced during the day, we may already understand better what is depriving us of sleep.
Let us take as an example a weakened immune system as a result of unhealthy sleep. The immune system is regenerated during deep sleep. If the immune system becomes weaker, you can assume that a lack of deep sleep might be behind it. We now know that physical tiredness promotes deep sleep. So a sleep coach’s conclusion could be: do more exercise. If it just could be that easy! However, I confess that while this was simplified, it is not far from reality. Sleep education, the knowledge of sleep, is a great support for a sleep coach as well as for someone who is affected by insomnia.
Pandemics, stress and obesity
I now go back to a topic that, even if we would like to just not hear or read anymore about it, is all over us: the pandemic. In many countries, curfews are implemented, schools are closed and so are many so called non-essential shops, including fitness studios and sport clubs. The result of it is being assessed by medical doctors and psychologists. Of course, we all are only at the beginning of our findings, but first voices notice following symptoms: increased stress levels, increased domestic violence, increased depression or anxiety disorders including suicide attempts and increased obesity issues. There is only one topic here that I have not addressed at all until now: obesity. One might think, that this is happening during this period because people are bored and eat more, while they make less sports. This is only partly true, which is why I would like to introduce one more detailed description about our hormones, our circadian rhythm and the BRACs. Those cycles are what keep our bodies in tune: once they get out of balance, it can become very difficult to bring them back to their natural state.
Let us start from the beginning: our natural inner clock does not only set the time for sleeping, but also the time for when we are most focused and the one for being hungry. If stress comes around and disrupts a night of sleep, the ghrelin levels in our body rise. Ghrelin is a hormone that stimulates appetite. Usually, when the circadian rhythm is in balance, the ghrelin level is at its peak in the evening. However, if we did not sleep enough, it now is at a higher level altogether, which is why we tend to eat more. This increased appetite effect worsens in cases of chronic sleep deprivation, as then, also the hormone leptin is lowered, leading even more to the feelings of intense hunger and the choice of rather unhealthy food with high calories. We eat, even though the body does not need food, it just has received a false hormonal message due to sleep deprivation. I might add here, that ghrelin has been discovered only recently, only in 1999 was it finally isolated by Kojima and Kangawa et al.. Medical researchers still work on fully comprehending the interaction of ghrelin with the other hormones connected to our guts. All hormonal imbalances are very complex studies and will probably keep researchers busy for many years to find out about many of the interactions between those hormones. Ghrelin seems to also influence the amount of REM sleep we get, and of course, as a consequence, also the amount of the other sleep stages like N1 and N2. Further, it also has an anti-depressant effect, the problem with it, is that after food intake, the ghrelin level drops again, so basically, the strongest effect of a high ghrelin level, unfortunately, is an increased appetite. Sports would of course be very helpful in this case. Not only does sports burn calories, it also reduces stress levels, increases dopamine release and the physical tiredness promotes deep sleep and increases sleep pressure. However, outdoor sport has become difficult in times of lockdowns, but here might be some good indoor solutions, like Zumba or comparable home training techniques.
Physical and psychological conditions that prevent healthy sleep
Even though it seems clear already, I would like to point out that the method of sleep coaching is a non-drug therapy that cannot address physical issues leading to unhealthy sleep. Some of those, mostly neurological issues, can be:
· Restless Leg Syndrome,
· bruxism (teeth grinding),
· REM sleep behavior disorder — in REM-sleep we usually cannot move, while people suffering from REM sleep behavior disorder can act out violently during a dream or talk, or making noises.
· Sleep walking also is a Parasomnia categorized sleep disorder, but it differs from REM sleep behavior disorder as it does not occur during REM-sleep, thus, if patients wake up from it, they do not remember any dream content.
· Dementia also can lead to sleep issues — people suffering from dementia often have a fragmented sleep pattern and encounter difficulties to fall asleep after waking up, often they chose to get up and walk around. They experience less deep sleep and less REM sleep.
Nevertheless, in some cases, sleep coaching can offer some relief to compensate the day time sleepiness resulting from the disorders.
As such, sleep coaching also can be of complementary to treating many psychological issues, like:
· Depression — Here, we face a situation in which we hardly can know what came first: the sleep issue or the depression. We do know that sleep deprivation can lead to depression, as much as depression can lead to unhealthy sleep and sleep deprivation.
· Anxieties — Here we face the same situation than with depression
· Bipolar disorder
· Personality disorder like narcissism
· Post-Traumatic Stress Disorder PTSD — this is a case that I will address more in detail in the part dedicated to dream work.
In those cases, it would be important to consult a sleep coach who also is a professional psychotherapist.
Further, many diseases related to breathing, like asthma, also have a negative effect on sleep, as one condition to healthy sleep is breathing well. The body needs oxygen while sleeping in order to fulfill all the tasks needed. This also explains why people suffering from Sleep Apnea (interruption of breathing while sleeping, usually connected to loud snoring) often need more hours of sleep if they want to feel rested after waking up. Sleep apnea can be a serious condition that needs to be addressed and diagnosed in a sleep laboratory. Obesity also can be one reason for sleep apnea, but unfortunately not the only one.
Of course, the list above is not exhaustive. Many neurological issues can lead to sleep disorders, like a stroke for example, that can disrupt sleep or lead to many nightmares while recovering from it. What we all know: pain also prevents sleep and is a symptom of many diseases and injuries. Sleep coaching might help in many cases and support recovery, but it always is better to consult a medical doctor, preferably one trained also in sleep coaching, before addressing the sleep issue itself. It is important to keep in mind physical or psychological issues that might be at the origin of daytime sleepiness and/or of a sleep disorder.
Food and sleep
As we already understood with all the information mentioned above, sleep is a result of what happens during the day. For example, sport has a stress lowering effect, increases sleep pressure and promotes deep sleep: those are daytime activities. Another aspect of sport is that it makes our bodies release the hormone serotonin. Serotonin is not only a “happy making” hormone preventing depressions, it also is needed to produce melatonin, our famous sleep hormone, which I already mentioned above. One more important thing happens, when our bodies burn energy while we are active: the adenosine level in our bodies increases. During the day, we cumulate adenosine in our bodies, and when we reach high levels, our heartbeat slows down, our blood pressure lowers, which leads to sleep pressure, in other words: it makes us tired. Let us summarize this in an easy equation type of description:
Sport →Serotonin release →Serotonin is used to produce melatonin = Sleepy
Sport →Burns Energy →Adenosin level rises →heartbeat slows down + Blood pressure lowers = Sleepy
This is where the topic of food becomes important. To burn energy during the day, we first need energy intake. This is why a great way to start the day is to have a high energy containing breakfast. Bread with cheese, ham or marmalade, bacon and eggs, muesli, orange juice or other fruit juices for the vitamin C, and so on. The choice is yours, depending on your preferences, just you need to know that breakfast can be high in calories. Breakfast time also is a good opportunity to use the wakening effect of light. The best would be to have a breakfast intake while sitting in a sunny place, or by using one of the bright lamps (at least 2000Lux) to compensate the lack of sunlight (for example during winter season). Our body will start producing Vitamin D (thanks to the sunlight) and at the same time, melatonin will stop to be released, even if outside it is still dark (in wintertime or for shift workers, the “days” unfortunately often start in darkness). We are now fully awake and we can burn all the energy we got from our food intake. As the morning passes by, do not hesitate to eat a little snack in-between the meals, it actually is better to eat about 5 times a day, rather than to stick to the usual 3 main meals. Italians might choose a tramezzini as a snack, but any small sandwich would be good, include some vegetables like cucumbers or tomatoes, fruits can be added to it or replace the sandwich altogether, a yoghurt can be added to the snack for additional proteins. As the day is still long, you do not need to fear some little more calories to be included in this snack.
While the day continues, you burn those energy sources which you ate and the level of adenosine increases. At about 1 PM, it is lunch time. Try to make this the main meal of the day, choosing among all possibilities according to your taste or to the diet you are following (low carb, vegan, vegetarian and many others). Of course, it always is better to not focus only on proteins (meat, fish, eggs, soybeans), but to take into account the right balance between fats, fibers, vitamins and all the other nutrients. As you had a good breakfast and a little snack, you might be hungry at the time, but not too much. This is good and important, as our bodies need energy to digest. If you had not eaten enough in the morning, you would have so little energy left, that after lunch, you would feel tired. This happens, when the digestive system needs the rest of energy you still have just to be able to digest. Nevertheless, if you have the possibility, it might be good to grant yourself a small nap after lunch time, about 15 minutes, which is short enough to not drift into deep sleep stages from which it is more difficult to wake up. A short nap will reset your mind and body and energize you, so that you can be focused, concentrated and dynamic in the afternoon. Most people tend to have more energy in the morning, but it is also a matter of choosing the right foods to boost the energy levels in the afternoon.
If you find time for it, from a health perspective, it would be good to do some sport in the middle of the afternoon and have a little snack after it. At this time of the day, it already is important to not eat too many calories, as soon, your metabolism will not be able anymore to transform them into energy. Once your body goes into night mode, also your digestive system runs low and while you sleep, it is busy cleaning your body off toxins. The snack after sport might already be tryptophan containing food, like nuts (especially cashew), slices of turkey, tuna, cheese, soy, banana. (Note: One of the famous superfood algae, spirulina, contains a high level of tryptophan.) As sport triggers your body to produce serotonin, the intake of tryptophan is important, as it is needed to be broken down into serotonin.
As the evening approaches, it is time to think about what you want to eat for dinner. It should be easy to digest, therefore avoid raw foods. Boiled vegetables (in a soup, for example) light fat-free boiled meat or fish, cheese are all good ingredients for dinner. The best time to eat would be at latest 4 hours before bedtime. If you still feel a bit hungry at a later point, banana chips (with no sugar added) or a handful of nuts are the best bedtime snacks. At this time of the day, your adenosine level is already high, you produced a lot of serotonin, which now can be transformed into melatonin: from a hormonal point of view you are ready for bedtime, as soon as you dim the lights. The only thing left for you now is to get rid of stress and leave the day behind you, do some activities that calm you down and bring your thoughts away from work topics. When you are ready for bed you now can get into a bedtime ritual, as we will describe in the next part.
To avoid in the evening: all kind of energy drinks, coffee, caffeine containing tea, chocolate.
Alcohol also is preventing healthy sleep, as it disturbs the sleep stages and prevents your body to fulfil its nightly tasks. One glass of beer can help to get tired, as the hop contained in it promotes the production of melatonin. Be careful though to not drink it regularly, it should not be used as sleep medicine, as it contains alcohol. If you still feel like eating something sweet, you might want to try one piece of chocolate, only the dark one though and really only one little piece. Cocoa has a calming effect, even though it contains caffeine. There are some brands that offer caffeine free chocolate, that would be perfect, if you can find some in your shops. As for the beer, it is a matter of quantity to have the beneficial effects without reaching the harmful ones.
One important thing to mention is the water intake. Water is life, as some advertisement used to tell rightfully so. Drinking enough water throughout the day will prevent from needing to drink too much water before bedtime which could disrupt sleep by forcing you to go to the restroom in the middle of the night.
If you need to get up during the night anyway, be it for going to the restroom or because something woke you up, try avoiding to talk or to switch on the lights. Do what you have to do and return to bed without losing your “sleep mode”.
If your lifestyle is allowing you to always getting up, eating and going to bed at the same time, you have all tools in your hands to benefit from healthy sleep, as your circadian rhythm likes to stick to routines. If you are a morning person but need to go to work late and be more active in the afternoon and in the evening, you still can get into it and teach your body to adjust your circadian rhythm to the circumstances. A regular lifestyle with regular hours is what shift workers are missing and this is why shift work is considered very unhealthy. There is a lot that can be done to counter the negative effects of shift work from a sleep coaching perspective, but it is so specific, that it would take too much space here to go into details. Just so much about food in case of shift working: it is very helpful to plan 6 meals during the waking period. Setting those “meal times” right, they can be taken every day at the same time, no matter the shift. The only thing that will change is which of those meals will be the main meal of the day and which ones will be the little snacks. This way, you have a regular pattern, that can be kept and your body does not need to readjust at which time it gets hungry.
Conclusion of sleep education
The sleep coach is not the only one searching for solutions to overcome unhealthy sleep: the person affected by it is the real main actor. The sleep coaching(®Klösch & Holzinger) method is not an authoritarian, dogmatic method with something like a 10-point program. That is also the reason why we have called it “coaching”: we help people with insomnia to find out how they can find their way back to healthy sleep. I say “find back” because we were all born with the ability to sleep well, we only lost that ability along the way. Finding out how this got lost, through which experience, through which living conditions, habits or events, is a task each single person can achieve. There is no magic solution for the human psyche, each of us has his own dynamics and personality. Therefore, sleep coaching(®Klösch & Holzinger) is a flexible method that can be individually adapted.
Our approach is based on the methods of Gestalt, in which every person is strengthened until he has the strength and knowledge to take self-determined responsibility for his psychological well-being.
I hope that in this part I offered enough knowledge for the reader to better understand what is going on in the body and in the psyche while sleeping, or while not managing to sleep. In the next part, Cognitive Behavioral Therapy for Insomnia, CBT-I, we get into all the measures that can be taken to directly address the elements that prevent a healthy sleep. The advantage of CBT-I is that it offers easy and fast helping solutions to address unhealthy sleep. With all the knowledge we acquired in sleep education, many of the measures shown in the next part will make sense right away, as they build on the knowledge and understanding we now have about sleep. Just to name a few elements part of this crucial knowledge base: the effect of light, of sports, of distress and eustress, the circadian rhythm. The Gestalt based idea of sleep coaching which involves taking different elements together to form a new whole, to form a consistent and coherent concept, will start to come into place.