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Eye on Psi Chi: Summer 2012
Sleeping Well for Better Life With Dr. Richard Bootzin
Meagan Frey, University of Tennessee at Chattanooga

Early Career and the Importance of Sleep
Richard Bootzin, PhD, is a clinical research psychologist and professor of psychology and psychiatry at the University of Arizona in Tucson. He is also the director of the insomnia clinic at the University Medical Center and the sleep research laboratory in the psychology department. Today, he is considered one of the leading researchers in the field of sleep and insomnia.

"Sleep is at the core of the rest of our lives: It affects cognition, regulation of emotion, health, our capacity to think clearly, and our ability to have enough energy to engage in activities. It affects us fairly broadly,” says Dr. Bootzin. "At every developmental age, persistent sleep problems cause problems in other areas of functioning. People who have persistent sleep disturbance are more likely to have issues with anxiety, depression, impulsivity, drugs, cognition, memory, and problem solving. The consequences of not getting sleep or having a disturbed sleep schedule are rather substantial. We live in a fast-paced society where people expect sleep to take care of itself, but there is good evidence that having an irregular sleep schedule does not give you the resources to deal with all aspects of life.”

Dr. Bootzin became interested in sleep research, insomnia in particular, when he was at Northwestern University (IL) teaching abnormal psychology. "One of my students asked if I knew anything about insomnia because her husband had a fairly severe case. I didn’t know anything then, but began to look into treatments that were not medication based,” Dr. Bootzin recalls. "Most of the treatments I found talked about relaxation training, but, at the time, I was interested in the self-control treatments using stimulus control. So I suggested to the student that we develop a set of instructions based on stimulus control, and it worked very well.”

The Stimulus Control Treatment for Sleep
Stimulus control, a method of treatment developed by Dr. Bootzin, is one of the most effective treatments for insomnia. Stimulus control is a "strategy for self-modification that depends on manipulating the cause of behavior to increase goals or behaviors desired by a patient while decreasing those that are undesired” (Mosby’s Medical Dictionary, 2009). "It was already a principle within learning psychology (used for dieting and smoking), but it had not been applied to sleep or insomnia,” says Dr. Bootzin. "The idea is that there are certain cues that trigger various kinds of responses. For example, if you study in bed, it is likely that the bed and the cues for bed will make you sleepy; therefore, if you study in bed, you will be more likely to fall asleep rather than study. Likewise with studying at the kitchen table: You are more likely to be reminded that you are hungry and eat instead of study. The stimuli do not control everything, but they may trigger information and responses that compete with whatever it is that you are trying to accomplish.”

"For someone who wants to sleep well, it is important not to use the bed or bedroom to do things that compete with sleeping: worrying, reading, watching television. Preserve the bed and bedroom as strong cues for sleep so that when you want to go to bed, you are not reminded of other things you want or need to do. By strengthening the cue for bed and eliminating cues that compete with sleep, you will sleep better.”

Dr. Bootzin says that stimulus control treatments are considered one of the best non-pharmacological treatments for insomnia as a single treatment. "What has happened over the past ten years or so is various treatment elements have been combined with each other to make for a more integrated treatment in which other components are also included, such as cognitive therapy focused on attitudes and beliefs about treatment, or relaxation focused on reducing arousal. Treatments are less likely to be evaluated as single entities, but rather as a combination of treatments. Stimulus control continues to be one of the core elements of any of these combination treatments,” Dr. Bootzin states.

"Not everyone has to banish eating, reading, or watching television from the bed: only those who have trouble getting to sleep at night. If you are a worrier or have a racing mind, you could take time out of your day to review your worries, write them down when you are not tired, or reserve the worries for the morning. Many people find that when they wake up, the things that they were worried about in the middle of the night do not seem so unsolvable,” Dr. Bootzin suggests. "The primary part of the stimulus control rules that deal with worries and mind-racing is not to stay in bed if you have not fallen asleep within 15 minutes. If you stay in bed worrying, you are associating worrying with the bed. Instead, get up, go into another room, think about things, write them down, whatever you have to do. When you have done as much as you can, go back to bed and tell yourself, ‘I’ve done all I can do for now; save it for the morning.’ Do not associate worry with the bed or bedroom. If you are worrying or distressed about not sleeping, you should be out of bed.”

One of the most important aspects of sleep, according to Dr. Bootzin, is having a regular schedule seven days a week: one where you are awake during the day and asleep during the night. "The most important point for college students to remember is to keep a consistent sleeping schedule. It is hard to actually maintain because there are so many pressures to violate it: being up late for parties and pulling all-nighters to study—all of these things affect sleep. Although young adults are more adaptable than older adults, they are not invulnerable to problems. We often have the feeling when we are 20 that it does not matter when we sleep because we will always be able to catch up, but we do not completely catch up, and we throw off our natural sleep-wake rhythm. We do better by being more consistent.”

Future Research
As for future research, Dr. Bootzin currently has two projects in the startup phase: one dealing with the impact of sleep on people going through divorce, and how sleep effects their resiliency and ability to deal with the situation. The other study involves older individuals who sleep longer than average and what positive or negative outcomes occur when their time in bed is reduced by one hour a night. "We don’t have preconceptions about whether this modest change of one hour will be good or bad for people, but we want to find out what exactly are the effects on sleep, health, immune functioning, and daytime sleepiness,” says Dr. Bootzin.

Tips for Students
For students interested in entering the field of sleep research in graduate school, Dr. Bootzin says the most important thing to do is gain experience in sleep research. "If people at your school are doing research on sleep, working as a research assistant or doing an independent study is a real plus. There are sleep disorder centers at many major hospitals that you could work at. Becoming a sleep technician and getting experience in the psychophysiology of sleep at those centers will also put you ahead. When people apply to work with me, I almost always ask them what actual experience they have had with sleep. Simply reading or talking about it in class is usually not enough; you need to have some actual experience, as well. However, having an interest in sleep is seldom enough to get into a good graduate school.” says Dr. Bootzin.

The field of sleep research has been a hot topic in psychology for a very long time, and it continues to be a growing area. Dr. Bootzin has pioneered methods of treatment for insomnia through his research and encourages students of psychology who are interested in sleep to further their education and help contribute to this dynamic field.

References
Stimulus Control. (2009). In Mosby’s Medical Dictionary (8th ed.). Retrieved from Here

Richard R. Bootzin, PhD, is a professor of psychology at the University of Arizona. He is the recipient of the 2008 Mary A. Carskadon Outstanding Educator Award from the Sleep Research Society and the 2011 Distinguished Scientist Award from the Society for a Science of Clinical Psychology. Dr. Bootzin has coauthored successful textbooks for introductory psychology and abnormal psychology and is a frequent grant reviewer for NIH and NASA. He is president of the board of the Psychological Clinical Science Accreditation System, a new organization that strengthens the role of psychological science within clinical training programs. Best known for his research on sleep and insomnia, Dr. Bootzin has extended the treatment of insomnia to adolescents. He is also involved in basic research in sleep and its impact on memory, learning, and health.

Copyright 2012 (Volume 16, Issue 4) by Psi Chi, the International Honor Society in Psychology

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