db 620 PSYC

Breaking a Long-Term Pattern of Poor Sleep

1: Introduction

0 seconds DR. EDWARD J. STEPANSKI

[00:00] DR. EDWARD J. STEPANSKIOkay, my name is Dr. Stepanski and I’m a clinical psychologist and a sleep specialist, and I’m going to talk to you today about your difficulty with sleep to figure out what we can do to help you. LEEANNE: Okay. DR. EDWARD J. STEPANSKI: Okay and your name is?

12 seconds LEEANNE

[00:12] LEEANNELeeAnne [inaudible] DR. EDWARD J. STEPANSKI: Okay, nice to meet you. LEEANNE: Nice to meet you. DR. EDWARD J. STEPANSKI: How are you feeling today? LEEANNE: I’m feeling good. DR. EDWARD J. STEPANSKI: Alright, very good.

17 seconds DR. EDWARD J. STEPANSKI

[00:17] DR. EDWARD J. STEPANSKIWell, to start off, if you could just tell me about your sleep in general that would be helpful to me. LEEANNE: I get about four to five hours of sleep a night, usually

27 seconds LEEANNE

[00:27] LEEANNEit’s pretty broken. I usually try to stay up as late as I can to make myself real tired usually till, you know, 11 or 12 o clock watching TV or doing something around the house. I sleep from usually 11 until lately it’s been about 1 o’clock in the morning, and in those two hours I dream and my dreams basically seem so real to me that I bring myself out of my sleep and I have to sit and think of it, my dream it was true, if it actually happened or if I was dreaming and that usually, you know, sometimes I have to wake my husband and then I usually go down and wander around the house and do something until I’m tired again and go back up to bed and usually around when my husband leaves around 6 o’clock, 5:30 or 6 o’clock in the morning I usually fall back to sleep till around 7:30 to 8 o’clock, so it’s basically about four and four and a half hours sleep at night.

1 minute 27 seconds DR. EDWARD J. STEPANSKI

[01:27] DR. EDWARD J. STEPANSKIOkay and how long if you had that kind of sleep.

1 minute 32 seconds LEEANNE

[01:32] LEEANNEA little over 18 years, we can basically remember that I’ve been sleeping like this. DR. EDWARD J. STEPANSKI: Okay and before 18 years ago,

1 minute 42 seconds DR. EDWARD J. STEPANSKI

[01:42] DR. EDWARD J. STEPANSKIdid you sleep differently? LEEANNE: Soundly, we just feel right now, we’re

1 minute 47 seconds LEEANNE

[01:47] LEEANNEjust kind of discussing it last night and it’s usually when something is real stressful or something has happened, which 18 years ago, my husband had a major accident and that’s probably when it all started because I keep reliving things over in my dreams. DR. EDWARD J. STEPANSKI: Okay, so your difficulty with sleep

2 minutes 12 seconds DR. EDWARD J. STEPANSKI

[02:12] DR. EDWARD J. STEPANSKIagain at the time of your husband’s accident. LEEANNE: Yeah. DR. EDWARD J. STEPANSKI: Okay and has continued ever since. LEEANNE: Yeah, it’s been one thing

2 minutes 22 seconds LEEANNE

[02:22] LEEANNEafter another in our lives and it’s usually one thing start settling down at one thing something else comes up and that’s usually when it starts over again.

2 minutes 32 seconds DR. EDWARD J. STEPANSKI

[02:32] DR. EDWARD J. STEPANSKIOkay can you tell me a little bit about the circumstances of your husband’s accident? LEEANNE: He was

2 minutes 37 seconds LEEANNE

[02:37] LEEANNEChicago fireman and he was crushed on a fire truck and he wasn’t expected to live for like two weeks. They didn’t know exactly what they could do to help him and then I was I had a three-year-old at home and two-year-old and I was pregnant with number three, I was a month pregnant. DR. EDWARD J. STEPANSKI: So that was a really rough time. LEEANNE: It was a very rough time and not knowing maybe he was going to make it through and what condition he was going to come of it, they won’t even expecting him to walk when he did finally stabilize and I’m just being pregnant and having two kids and we had a lot of help with our families, but it was just the stress of not knowing how I was going to pay the mortgage and that’s probably the only thing I did do is pay our mortgage. I was never home.

3 minutes 27 seconds LEEANNE

[03:27] LEEANNEHe was in the hospital from December 30th of that year, he came home probably the beginning of the April, but he had a what’s called Pittsburgh brace was screwed through his body, instead of putting in a body cast because he required so much surgery, they put him in what’s called Pittsburgh brace and they had these rods drilled through his body and he finally came home, but then he was in bed for three months with this brace on. DR. EDWARD J. STEPANSKI: So would you have to take care of him? LEEANNE: Well, because I was pregnant and he works for the City of Chicago, we insisted on a private nurse, so I wouldn’t have to deal with him and being pregnant and the two kids and trying to take care of the house. So around, I want to say June or July, he went and had that brace taken off, but then it was a matter of going I would drive him as he couldn’t drive. He had lost like 100 pounds and he couldn’t drive, he couldn’t even walk, so and I was taking him for therapy every single day with the two kids. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: So it was like my life was consisting of him. DR. EDWARD J. STEPANSKI: Yeah, and I can see where you would have had lots of reasons, not with sleeping real well

4 minutes 47 seconds DR. EDWARD J. STEPANSKI

[04:47] DR. EDWARD J. STEPANSKIat that point in your life. LEEANNE: Yeah. DR. EDWARD J. STEPANSKI: Well, then to look at your schedule right now, it sounds like the earlier you might fall sleep would be around 11, is that right? LEEANNE: Yeah

4 minutes 57 seconds LEEANNE

[04:57] LEEANNEmore times like the other night I was so tired I was like 8 o’clock because I’m so tired then after I’m not getting a good night sleep. DR. EDWARD J. STEPANSKI: So how often would

5 minutes 7 seconds DR. EDWARD J. STEPANSKI

[05:07] DR. EDWARD J. STEPANSKIsomething like that happen? LEEANNE: Oh, it happens quite often. I’m usually, you know, depending on

5 minutes 12 seconds LEEANNE

[05:12] LEEANNEmy day and how busy I’m, if I can I usually end up going to bed about 8 o’clock, but then it seems like that cycle starts earlier then. It’s like then I’m getting up at 11 or 12 o’clock starting to dream all over again. DR. EDWARD J. STEPANSKI: Okay.

5 minutes 27 seconds DR. EDWARD J. STEPANSKI

[05:27] DR. EDWARD J. STEPANSKISo on the other side you might be out of bed

5 minutes 32 seconds 7

[05:32] 730 or eight at the latest? LEEANNE: Yeah. Like this morning I was up at six. DR. EDWARD J. STEPANSKI: Okay.

5 minutes 37 seconds LEEANNE

[05:37] LEEANNEBut I didn’t have such severe dreams, so I kind of slept through them.

5 minutes 42 seconds DR. EDWARD J. STEPANSKI

[05:42] DR. EDWARD J. STEPANSKIOkay. How much sleep do you think you need be rested?

5 minutes 47 seconds LEEANNE

[05:47] LEEANNEI tried to get seven or eight anything more than eight I’m like nonfunctionable, you know, if I get too much then it’s like I don’t do very well. DR. EDWARD J. STEPANSKI: Okay. How

6 minutes 2 seconds DR. EDWARD J. STEPANSKI

[06:02] DR. EDWARD J. STEPANSKIoften you actually get seven or eight hours. LEEANNE: Not too much, maybe one night a week. DR. EDWARD J. STEPANSKI: Okay, and on average, how much you’re getting? LEEANNE: About four and four and a half.

6 minutes 12 seconds DR. EDWARD J. STEPANSKI

[06:12] DR. EDWARD J. STEPANSKIOkay. Now how this has affect during the day?

6 minutes 17 seconds LEEANNE

[06:17] LEEANNEI stay pretty busy, I just try to keep myself busy around the house usually, I also think I have that sickness with the light where I need sunlight, so when it’s real gloomy, I have real bad days, but like days the rest two days that my doctor told me if I can get outside and just do something out there and get some sun and some fresh air and usually pretty good. DR. EDWARD J. STEPANSKI: Does it ever happen that you fall sleep unintentionally during the day? LEEANNE: No, I won’t allow that. If I sit down long enough, I probably would, but I try not to do that. DR. EDWARD J. STEPANSKI: Okay, so you’re falling asleep driving. LEEANNE: No. Never.

6 minutes 57 seconds DR. EDWARD J. STEPANSKI

[06:57] DR. EDWARD J. STEPANSKIDo you go to a movie theater at all? LEEANNE: No. I don’t sit still long enough to go with movie.

7 minutes 2 seconds DR. EDWARD J. STEPANSKI

[07:02] DR. EDWARD J. STEPANSKIOkay. LEEANNE: I’m very jumpy and so

7 minutes 7 seconds LEEANNE

[07:07] LEEANNEwe don’t do movie theaters too often. DR. EDWARD J. STEPANSKI: Okay.

7 minutes 12 seconds DR. EDWARD J. STEPANSKI

[07:12] DR. EDWARD J. STEPANSKISo there is no situation where you likely to dose off? LEEANNE: No. DR. EDWARD J. STEPANSKI: Okay.

7 minutes 17 seconds LEEANNE

[07:17] LEEANNENot at all. I’m pretty alert during the day. DR. EDWARD J. STEPANSKI: Do you take naps during the day on purpose. LEEANNE: No. Because if once I wake up I’m non-functionable. I don’t feel like I want do anything. I’m basically on the go most of the day, doing something in the house, doing something. I do lot of running around. My kids are all grown, but I usually trying to keep myself pretty busy.

2: Assessment: Substance Use

7 minutes 42 seconds DR. EDWARD J. STEPANSKI

[07:42] DR. EDWARD J. STEPANSKIOkay. Do you drink coffee.

7 minutes 47 seconds LEEANNE

[07:47] LEEANNEProbably, a little bit too much, I’ve been trying to cut down. DR. EDWARD J. STEPANSKI: How much coffee

7 minutes 52 seconds DR. EDWARD J. STEPANSKI

[07:52] DR. EDWARD J. STEPANSKIdo you drink? LEEANNE: Well, according to my coffee pot, it says eight cups, but it’s probably about

7 minutes 57 seconds LEEANNE

[07:57] LEEANNEtwo real big ones. DR. EDWARD J. STEPANSKI: So eight regular size or two really

8 minutes 2 seconds DR. EDWARD J. STEPANSKI

[08:02] DR. EDWARD J. STEPANSKIlarge? LEEANNE: Two really large cups and that’s usually right away in the morning. DR. EDWARD J. STEPANSKI: That’s all in the morning? LEEANNE: Yeah. I

8 minutes 7 seconds LEEANNE

[08:07] LEEANNEdon’t drink any coffee at all after like 8 o’clock, seriously between six. If I wake up six, I usually have it right away at 6:30. If I wake up past 8 o’clock, I probably don’t even brew a pot a coffee, but caffeine is...(crosstalk) DR. EDWARD J. STEPANSKI: So you mean some days you wouldn’t drink any coffee at all.

8 minutes 27 seconds LEEANNE

[08:27] LEEANNEYeah. Because I drink past a certain time then I kind keep track of if I have too much coffee those nighttime not sleeping well. And there have been a few nights where I’m up working on the computer and stuff on all brew a pot a coffee and them I’m not sleeping at all, but I just kind to put that off to having too much coffee late night. DR. EDWARD J. STEPANSKI: Okay. Do you drink caffeinated soft drinks? LEEANNE: No. I don’t drink. I’ve cut down on soda drastically, so I hardly drink any kind of soda. DR. EDWARD J. STEPANSKI: Okay. How about alcohol? LEEANNE: I have a few beers once in a while when we go out. We’ve date night once a week where we go out and have a few. DR. EDWARD J. STEPANSKI: What’s the most you might drink? LEEANNE: Maybe on a Friday night like two or three bottles. DR. EDWARD J. STEPANSKI: Okay. Does that affect your sleep at all?

9 minutes 17 seconds LEEANNE

[09:17] LEEANNENo, but usually helps me. DR. EDWARD J. STEPANSKI: Does it consistently help you? LEEANNE: Yeah. It relaxes me.

9 minutes 22 seconds DR. EDWARD J. STEPANSKI

[09:22] DR. EDWARD J. STEPANSKIDo use tobacco?

9 minutes 27 seconds LEEANNE

[09:27] LEEANNENo. I quit when I was pregnant. So I don’t smoke at all. DR. EDWARD J. STEPANSKI: Alright, good.

9 minutes 32 seconds DR. EDWARD J. STEPANSKI

[09:32] DR. EDWARD J. STEPANSKIHave you ever used prescription medication for your sleep? LEEANNE: No.

9 minutes 37 seconds DR. EDWARD J. STEPANSKI

[09:37] DR. EDWARD J. STEPANSKIWhat about over-the-counter medications? LEEANNE: I usually don’t, no.

9 minutes 42 seconds DR. EDWARD J. STEPANSKI

[09:42] DR. EDWARD J. STEPANSKIYou usually don’t know. LEEANNE: No. I don’t at all. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: I have never used anything try to put me to sleep.

9 minutes 47 seconds DR. EDWARD J. STEPANSKI

[09:47] DR. EDWARD J. STEPANSKIOkay. Are you opposed to use some medication, is that the reason? LEEANNE: No. If I have the headache, I’ll take an aspirin, but I guess

9 minutes 57 seconds LEEANNE

[09:57] LEEANNEI never even thought about it to be very honest about going and finding something to help me sleep. I’m just afraid if I take something like that I might sleep too, I don’t like sleeping past the certain time in the morning because I feel like I waste my morning and my day then I’m a pretty, I like being up early and I like staying up late. So some people are morning people and some people are night people. DR. EDWARD J. STEPANSKI: You are both. LEEANNE: I’m kind of both. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: So...(crosstalk)

10 minutes 22 seconds DR. EDWARD J. STEPANSKI

[10:22] DR. EDWARD J. STEPANSKIAlright. Do you have other medical problems as we talked about so far. LEEANNE: Uh uh. DR. EDWARD J. STEPANSKI: Do you take any medications at all? LEEANNE: No.

3: Assessment: Mental State

10 minutes 32 seconds DR. EDWARD J. STEPANSKI

[10:32] DR. EDWARD J. STEPANSKIDo you think you’re an anxiously or nervous person at all.

10 minutes 37 seconds LEEANNE

[10:37] LEEANNEProbably very anxious. I think people say I’m afraid of being afraid, I don’t know you can understand that. DR. EDWARD J. STEPANSKI: Tell me more about that. LEEANNE: Well, it took me about five years to get my family’s, my husband skied when I first met him, he skied and I was just afraid of hurting myself, so I’m afraid that something might happened, so I’m afraid of being afraid. DR. EDWARD J. STEPANSKI: Do you think you are a worrier?

11 minutes 12 seconds LEEANNE

[11:12] LEEANNEI’m a big worrier. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: I’m always worried about the kids staying out later, what happens if they’re driving late so I worry when my husband doesn’t, so we’re like a good balance. DR. EDWARD J. STEPANSKI: Okay. Do you have, I

11 minutes 32 seconds DR. EDWARD J. STEPANSKI

[11:32] DR. EDWARD J. STEPANSKImean, are you worrying when you are lying down and trying to sleep at night? LEEANNE: Depends on the situation,

11 minutes 37 seconds LEEANNE

[11:37] LEEANNEyou never fall asleep until your kids are at your home and when you have teenagers that sometimes you are up quite late. Once he is in the house, I’m fine. I don’t sleep well when my husband when he was a fireman, he was on 24 hours or 48, so I just got, he was only on the fire department for three years when he got hurt, so I just got used to that schedule where I was in house alone with the kids, but now when he take, you know, he could he does a lot of snowmobiling and stuff with my son, when they’re gone and I’m in the house alone. I’m like I’m responsible now and I worry that someone might break-in and hear all the noises in your house, your furnace kicking on and off and so I usually don’t sleep and I don’t sleep at all when they’re gone.

12 minutes 27 seconds LEEANNE

[12:27] LEEANNEI usually wind the projects where I’m up all night doing something. DR. EDWARD J. STEPANSKI: Do you stay up on purpose. LEEANNE: Yeah, because I know trying to fall asleep I won’t. I’ll keep the TV on and I lay on bed watch TV or read, I try to read. DR. EDWARD J. STEPANSKI: And how do you do during the day then? LEEANNE: I’m fine. It’s like I’m not tired. It’s like my body falls asleep, but my mind doesn’t, I feel. I feel my body is well rested, sometimes I’m tired, but I just deal with it and in the minute it’s like the minute he comes home I can fall asleep and probably sleep for 24 hours, so...(crosstalk) DR. EDWARD J. STEPANSKI: Okay. Do you have

13 minutes 12 seconds DR. EDWARD J. STEPANSKI

[13:12] DR. EDWARD J. STEPANSKIintrusive of thoughts? I’m thinking of a situation where you would have some real upsetting thought that would come in to your mind and you try to put it out and you’re not able to.

13 minutes 22 seconds LEEANNE

[13:22] LEEANNEWhen I’m sleeping? Or when I’m awake? DR. EDWARD J. STEPANSKI: When you’re awake. LEEANNE: Never when I’m awake. It’s usually when I’m sleeping, it’s those thoughts creep in. DR. EDWARD J. STEPANSKI: When you are actually asleep.

13 minutes 32 seconds LEEANNE

[13:32] LEEANNEWhen I think I’m, see sometimes I have a hard time to stay for in if I’ve actually dreamed something or if I’ve actually lived at, and that’s when I wake up and I have to like call people to see if something happened to see if my dream was actually true or not because I actually feel like especially if I’m in the dream, sometimes I wake up like this was just my latest dream, I dreamed I was late for my grandmother’s funeral, she was like my best friend, but she has been dead for eight years and I woke up seriously thinking that was a day of her funeral and I was late for it and I was so confused when I woke up because it was so real to me. DR. EDWARD J. STEPANSKI: Okay, does it ever happen that you’ll

14 minutes 27 seconds DR. EDWARD J. STEPANSKI

[14:27] DR. EDWARD J. STEPANSKIhave a dream that someone’s in the room whether there is something going on right at the time and you can’t tell whether it’s real? LEEANNE: Yeah, that happens quite frequently when my brother died.

14 minutes 37 seconds LEEANNE

[14:37] LEEANNEMy brother died eight years ago. He was murdered by his father-in-law and him and I were 14 months apart so we had we are like best friends growing up and my husband, I had given my husband some after shave from him when we cleaned at all his stuff and my husband put that on and this happened five years ago, but it was like as soon I smelled that after shave, I like start talking to my brother and my husband thought I was talking to him and then he realized I wasn’t talking to him I was found asleep, I was sitting up in the side of the bed talking to my brother and that dream now happens, I want to say maybe three or four times a month where I literally can see my brother standing in our bedroom and I’m holding on a full-fledged conversation with him and my husband just let me talk to him because he thinks I need to talk to him.

15 minutes 37 seconds DR. EDWARD J. STEPANSKI

[15:37] DR. EDWARD J. STEPANSKIYou had some really tough things happened in your life? LEEANNE: I would

15 minutes 42 seconds LEEANNE

[15:42] LEEANNEsay it’s been quite trying for us. DR. EDWARD J. STEPANSKI: Yeah.

15 minutes 47 seconds LEEANNE

[15:47] LEEANNEYeah. DR. EDWARD J. STEPANSKI: How do you think you’re doing with the loss of your brother,

15 minutes 52 seconds DR. EDWARD J. STEPANSKI

[15:52] DR. EDWARD J. STEPANSKIdid you under go any kind of counseling at the time? LEEANNE: No.

15 minutes 57 seconds LEEANNE

[15:57] LEEANNEMy sister-in-law and I have become very close friends. Actually, she lived with us right after he died. She was pregnant with number three, so we had like something in common with my husband being hurt and my brother being killed. She was pregnant. She had two young girls. She lived with us until on the child was over for her father. And right now, she lived like not even five minutes away from me, so I’m helping her to raise the kids and I think by being so close to them, they’re such a reminder of my brother that I have some hard times dealing, I have a hard time dealing with his death, but it’s like therapeutic for me just to be with my sister-in-law and my nieces.

16 minutes 52 seconds LEEANNE

[16:52] LEEANNEand I do, you know, I could I help her drive the girls to school a lot I have to because the youngest one has never met my brother, so she is only going to get to know to him through our stories and pictures and stuff, so we have a lot of storytelling and we sit down with her. I used to baby sit for her a lot and we used to bring up a photo album and talk about him a lot. So I guess that it was good and bad that kind of situation was good and bad for me. DR. EDWARD J. STEPANSKI: So you are very much involve and trying to keep your brothers memory

17 minutes 22 seconds DR. EDWARD J. STEPANSKI

[17:22] DR. EDWARD J. STEPANSKIalive. LEEANNE: Yeah. DR. EDWARD J. STEPANSKI: Which is? LEEANNE: Which we have to for my nieces because

17 minutes 27 seconds LEEANNE

[17:27] LEEANNEthey were so young. DR. EDWARD J. STEPANSKI: Helps you some ways and hurt you in some other ways? LEEANNE: It does. It really does especially because one acts just like him and she looks just like him, so it’s very difficult and sometimes I wish I wasn’t so close to him because of that because they are such reminders, but it is good therapy. DR. EDWARD J. STEPANSKI: Okay,

17 minutes 47 seconds DR. EDWARD J. STEPANSKI

[17:47] DR. EDWARD J. STEPANSKIdoes it happen that you have to check the front door to make sure it’s locked several times at night?

17 minutes 57 seconds LEEANNE

[17:57] LEEANNEYes. I roam. I make sure all the doors are locked especially when you have a my 17-year-old comes home, I always want to make sure the house is locked up after I hear him pulling in and everything, but I think I do get up every single night and same time walk downstairs, make sure the lights are off, make sure the doors are locked and make sure the I keep outside lights on. DR. EDWARD J. STEPANSKI: Okay, and what time do you that? LEEANNE: About 1 o’clock when I wake from my dreams because my husband always wakes up when I’m doing then he says to go for your nightly stroll and I’m like yes. DR. EDWARD J. STEPANSKI: Check the perimeter of the home and make sure everything is secure. LEEANNE: Yes. DR. EDWARD J. STEPANSKI: Alright

18 minutes 37 seconds DR. EDWARD J. STEPANSKI

[18:37] DR. EDWARD J. STEPANSKIand do you do that again later in the night or...(crosstalk) LEEANNE: Sometimes, but usually

18 minutes 42 seconds LEEANNE

[18:42] LEEANNEif I feel pretty good about if I do, if I know I’ve done it once I usually don’t come back down. DR. EDWARD J. STEPANSKI: Okay.

18 minutes 52 seconds DR. EDWARD J. STEPANSKI

[18:52] DR. EDWARD J. STEPANSKIDo you ever find yourself counting things like if you’re going upstairs or steps or anything like that? LEEANNE: No, well, you have to

19 minutes 2 seconds LEEANNE

[19:02] LEEANNEI do that like taking something up or down the stairs, I have memorized how many steps I have only because when you can’t see them you have to know when you’re coming to the landing or getting to the top stairs, so I know all the stairs in my house I think it’s just repetition.

19 minutes 17 seconds DR. EDWARD J. STEPANSKI

[19:17] DR. EDWARD J. STEPANSKIOkay. Have you ever had panic attacks? LEEANNE: Oh, all the time,

19 minutes 22 seconds LEEANNE

[19:22] LEEANNEI’m not real good with a big crowd of people like when I met my husband, he is a very family person and I don’t want to say I wasn’t, but he is Irish and nothing against Irishmen, but they are very family people where it’s not just immediate family that’s get together that’s all the aunts and uncles and all the cousins, generations of people and when I first met him on her first holiday, I had to leave the basement of his mother’s house because I was starting to get so panicky that I felt like I was getting closed in because there were so many people in this room and as I wasn’t used to something like that. I don’t get panicky unless like when I used to when I first started skiing, I would get real panicky because I don’t have the fear of being on the mountain, I have the fear of the scenery, which I don’t know you can understand that, but when you look out and you’re above the clouds and you’re skiing and you see all the other mountains.

20 minutes 27 seconds LEEANNE

[20:27] LEEANNEIt’s like I can’t ski and watch that, but if I look at the ground I can do it. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: But I’ll get very panicky when I’m up there and...(crosstalk)

20 minutes 37 seconds DR. EDWARD J. STEPANSKI

[20:37] DR. EDWARD J. STEPANSKIDoes it ever happen that for no reason at all, just suddenly become extremely anxious and have to leave where you are? LEEANNE: No. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: During the movie Backdraft

20 minutes 47 seconds LEEANNE

[20:47] LEEANNEbecause my husband was a fireman, I had to get up him. I’ve never seen into that movie. It was probably the only time where and I have a tendency where I cannot watch any kind of violent movies and this happened basically after my brother died because he died such a violent death. I just can’t watch people. I can’t go to a movie or I won’t even watch a movie at home where there is gunfire, I mean, I was lying in bed one night and my husband was watching this movie, this person was being shot, but you can hear him like taking his last breaths and I just had to leave the room because I was starting to imagine my brother taking his last breaths, the way my sister-in-law described it to me because she was there when he died. I just had to leave the bedroom because for that reason, so I don’t watch any—unless it makes me laugh, I’m not going to watch a movie that’s basically my rule of thumb. DR. EDWARD J. STEPANSKI: Sounds

21 minutes 47 seconds DR. EDWARD J. STEPANSKI

[21:47] DR. EDWARD J. STEPANSKIlike a good rule of thumb. LEEANNE: Yeah. DR. EDWARD J. STEPANSKI: Have you felt at all depressed lately?

21 minutes 52 seconds LEEANNE

[21:52] LEEANNENot, well, when your kids start leaving the house, it was very hard my oldest is 21. He went to college when he was right before he turned 18, so it was very depressing because he was the one child that was at home a lot other than working in school, he was usually home, so him and I had a very good relationship. So him leaving was quite depressing for me, but and I went to the doctor and the doctor told me that this was quite normal for the first child may when they leave home that you’re going feel this way and I haven’t worked at all through my marriage just with my children, I had three and four years, so they were my job. Well, my daughter left, she is now in Colorado, going to school out there also. It wasn’t so tough because she was never home and now my 17-year-old just graduated high school and it’s becoming a little more tougher because it’s like I have lost my job literally, so I’m working on that. DR. EDWARD J. STEPANSKI: Alright. So is she

23 minutes 2 seconds DR. EDWARD J. STEPANSKI

[23:02] DR. EDWARD J. STEPANSKIstill home? LEEANNE: My son and my youngest. DR. EDWARD J. STEPANSKI: Your youngest is son. LEEANNE: Yes, my youngest is still home,

23 minutes 7 seconds LEEANNE

[23:07] LEEANNEbut he is like never home. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: And it’s like he doesn’t need me to help in carpool, I was the carpool mom, I was he was real heavy in the sports, so I was always driving him, it’s like when that last one doesn’t need you anymore, you’ve lost your job and it is depressing. It is very depressing so and it’s what we have now in our marriage is what most people have before children, we had our children right way. So it’s getting to learn to know your husband again without children around and finding things to do and getting hobbies and so we’re working on that together. DR. EDWARD J. STEPANSKI: How’s it going between the two of you? LEEANNE: Oh, real good. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: I mean, you know, it’s better now but it never was. DR. EDWARD J. STEPANSKI: Does he understand the problem you have with your sleep? LEEANNE: Yeah. DR. EDWARD J. STEPANSKI: Supportive of you?

23 minutes 52 seconds LEEANNE

[23:52] LEEANNEOh very. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: He thinks I should he has been trying to get me to go to a sleep clinic for years. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: For how I sleep?

4: Assessment: Physical Health

24 minutes 2 seconds DR. EDWARD J. STEPANSKI

[24:02] DR. EDWARD J. STEPANSKIHow’s your appetite been? LEEANNE: Very strong. I can probably eat the

24 minutes 7 seconds LEEANNE

[24:07] LEEANNErefrigerator sometimes. DR. EDWARD J. STEPANSKI: Did you have a change in your weight? LEEANNE: A lot.

24 minutes 12 seconds DR. EDWARD J. STEPANSKI

[24:12] DR. EDWARD J. STEPANSKIFor compare to weight today to one year ago, how different would it be? LEEANNE: About 17 pounds.

24 minutes 17 seconds DR. EDWARD J. STEPANSKI

[24:17] DR. EDWARD J. STEPANSKIUp? LEEANNE: Yes. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: I guess because we’re going out to eat more

24 minutes 22 seconds LEEANNE

[24:22] LEEANNEthat’s a big problem. DR. EDWARD J. STEPANSKI: Okay, has he ever told you that you snore when you sleep?

24 minutes 27 seconds LEEANNE

[24:27] LEEANNEI don’t. He, I don’t snore when I sleep. He knows that, he snores I talk. DR. EDWARD J. STEPANSKI: And has his snoring ever disturbed you?

24 minutes 37 seconds LEEANNE

[24:37] LEEANNEAll the time. DR. EDWARD J. STEPANSKI: What do you do about that? LEEANNE: It depends if, if he is in a real hard to sleep, I try to nudge him to roll him over and if he continues rolling back over onto his back and snoring I find an empty bed in the house, which we have a lot of these days and I’ll go crawl into bed or I’ll go down and watch TV or something and fall asleep, so it’s never been a problem between us. DR. EDWARD J. STEPANSKI: Okay. Now what I would like

5: Exploration of Sleep Concerns

25 minutes 7 seconds DR. EDWARD J. STEPANSKI

[25:07] DR. EDWARD J. STEPANSKIto talk about is exactly what’s going on at night. Do you actually go in to bedroom to watch TV? LEEANNE: Yes. DR. EDWARD J. STEPANSKI: Alright. So you’ll be in bed at what time? LEEANNE: Well,

25 minutes 22 seconds LEEANNE

[25:22] LEEANNEI usually go up around nine or 10 o’clock depending on what I’m doing if I’m working on the computer, it’s usually later, but because we both of us usually go up around 9 o’clock, we sit and watch the news. He usually falls asleep and I continue watching TV. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: Until I’m tired.

25 minutes 42 seconds DR. EDWARD J. STEPANSKI

[25:42] DR. EDWARD J. STEPANSKIWill you fall asleep with the TV on or do you turn it off first?

25 minutes 47 seconds LEEANNE

[25:47] LEEANNENo, I turn it off first. I find if I keep the TV on and fall asleep if I’m listening to TV and something comes on I kind of like start thinking about what’s on TV and then I start living what’s on the TV in my dream. DR. EDWARD J. STEPANSKI: Okay. So

26 minutes 7 seconds DR. EDWARD J. STEPANSKI

[26:07] DR. EDWARD J. STEPANSKIyou turn off the TV and then you’ll doze off. LEEANNE: Just go to bed. DR. EDWARD J. STEPANSKI: And kind of tell when you’re getting sleepy enough, so then you’ll turn the TV off. LEEANNE: Yeah. DR. EDWARD J. STEPANSKI: And fall asleep then you say wake up after couple of hours.

26 minutes 17 seconds LEEANNE

[26:17] LEEANNEUsually, right now my pattern is, I usually go sleep around 11 and my pattern, I keep track of how many hours I get it usually, now it’s like 1 o’clock in the morning, it used to be 2 o’clock—2:05-- I used to wake up every single night. DR. EDWARD J. STEPANSKI: Okay. So

26 minutes 37 seconds DR. EDWARD J. STEPANSKI

[26:37] DR. EDWARD J. STEPANSKIyou look at the clock and see what time it is when you wake up and you’ll go down and check the front door and...(crosstalk)

26 minutes 42 seconds LEEANNE

[26:42] LEEANNECheck the back door, check the garage door, I go down to basement. First, I get up and see if my son is at home because out of my bedroom one day, you can see where he parks. So if I know he is home I go down and make sure all the doors were locked and all the lights are off. On the weekends, I usually go down to see who’s staying overnight because they usually come home on Friday and Saturday night bunch of em order pizza, shoot pool as long as they are quite in the house I don’t care, so I just want to know who’s there if they call their parents to tell him that they are here, so their parents aren’t worrying, thinks like that and then I go back up. DR. EDWARD J. STEPANSKI: Okay and then what happens?

27 minutes 27 seconds LEEANNE

[27:27] LEEANNEI usually try to fall asleep after couple hours if I don’t I usually go downstairs and turn on the TV and flip through the TV for couple of hours. DR. EDWARD J. STEPANSKI: So you get back into bed and you might

27 minutes 37 seconds DR. EDWARD J. STEPANSKI

[27:37] DR. EDWARD J. STEPANSKIlay there a couple of hours. LEEANNE: Yeah, hoping to fall asleep again. It seems like if

27 minutes 42 seconds LEEANNE

[27:42] LEEANNEdepending on what dream I was having, sometimes I will start falling back to sleep, but I will start going into the same dream, it’s almost like I start I continue the dream. DR. EDWARD J. STEPANSKI: Okay.

27 minutes 52 seconds LEEANNE

[27:52] LEEANNEAnd when it’s bad enough, I usually don’t want to do that, so I usually go downstairs and watch TV. DR. EDWARD J. STEPANSKI: Okay and then what?

28 minutes 2 seconds LEEANNE

[28:02] LEEANNEWell, then the sun rises and my husband gets up and I start my day. DR. EDWARD J. STEPANSKI: So you may still be watching TV when he gets up. LEEANNE: I might have dozed on the couch maybe, but the TV is on and that very rarely happens. DR. EDWARD J. STEPANSKI: Does it ever happen

28 minutes 17 seconds DR. EDWARD J. STEPANSKI

[28:17] DR. EDWARD J. STEPANSKIafter the 1 o’clock awaking, you check things out, you go back to bed and fall right back asleep.

28 minutes 22 seconds LEEANNE

[28:22] LEEANNENo. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: I never fall, I never. DR. EDWARD J. STEPANSKI: You’re always awake for a while. LEEANNE: I never, I usually never fall back to sleep. This lasts since we’ve been home from vacation, it’s been I usually fall asleep after my husband gets up, starts taking a shower, I will fall back to sleep into the such a hard sleep you know, usually if like I look at the clock and it 7:30 to 8 o’clock and I don’t realize I’ve been sleeping for last three hours or something. DR. EDWARD J. STEPANSKI: Okay. You get two hours at the beginning and you’ll get at least two or three hours at the

28 minutes 57 seconds DR. EDWARD J. STEPANSKI

[28:57] DR. EDWARD J. STEPANSKIend and that’s your most common...(crosstalk) LEEANNE: That’s my pattern. DR. EDWARD J. STEPANSKI: Okay. How upsetting is it to you to have a pattern like that, I mean, it sounds like someone you’ve kind of adjusted to it. LEEANNE: I have. I can’t figure out what else to do it

29 minutes 12 seconds LEEANNE

[29:12] LEEANNEjust depends if something stressful going on I mean right know my husband’s job is stressful on him and after his accident, they said towards him becoming 50, he was going to start living like a 70 or 80-year-old man and he’s starting, he's going to be 49 next week and he’s starting and that's starting to worry us, that he is slowing down to the point where it may not be enjoyable for us, but it’s something we had to deal with so it’s hard on both of us that he is feeling this way. DR. EDWARD J. STEPANSKI: Okay.

6: Psychoeducation and Techniques

29 minutes 47 seconds DR. EDWARD J. STEPANSKI

[29:47] DR. EDWARD J. STEPANSKIWell, as far as your sleep goes, there is a couple of things that occur to me that you might want to try to make it better than it is now. First of all, I would be real surprised if you’re really in eight-hour sleeper, I think you’re probably someone who is a shorter sleeper than that based on how much sleep do you’ve been getting and how well you do with that lastly, eventually you get exhausted and sleep longer, but only because you’re sleeping so short.

30 minutes 22 seconds LEEANNE

[30:22] LEEANNERight. DR. EDWARD J. STEPANSKI: So my idea would be something like perhaps six hours of sleep if you had sound sleep

30 minutes 27 seconds DR. EDWARD J. STEPANSKI

[30:27] DR. EDWARD J. STEPANSKIand good quality sleep because it’s not just quantity obviously, it’s quality of sleep as well that if you had six good hours of sleep you might do pretty well. If you got the same six hours every single night, so there’s not nights with this four hours or less than that then you don’t need nights with seven or eight hours or more than that, is that seem like that might fit for you.

30 minutes 47 seconds LEEANNE

[30:47] LEEANNEIt would if I can get them altogether. DR. EDWARD J. STEPANSKI: Yeah. I think that’s the big part of a people

30 minutes 52 seconds DR. EDWARD J. STEPANSKI

[30:52] DR. EDWARD J. STEPANSKIalways feel better to get their sleep in a row then they do it have broken up and we know that sleep is more restorative if it’s more together than if it’s broken up and it’s not that you would fall asleep, sleep for six hours and never wake up that isn’t very common either. Usually, people do wake up during the night, but the idea would be that you would be able to return to sleep more easily than you are now, wouldn’t be this extended two or three hour or longer period of time that you are awake watching TV or checking things around the house and you get back to sleep faster.

31 minutes 27 seconds DR. EDWARD J. STEPANSKI

[31:27] DR. EDWARD J. STEPANSKISo, the first thing that we’d want to do is setup a schedule that would allow you to get six hours of sleep. You had a lot of things happen to you that is kept your sleep off balance and that all makes perfect sense to me that you wouldn’t have been sleeping well during the horrendous time when you had the young children and your husband was so ill and then when you lost your brother, it is just been enough things that you think is never really come back to the pattern that it might have come back to you before because of all these other and it kind of challenges to you. So at this point, you’re kind of entering a new part of your life where maybe things will settle down maybe it is a period where you could put your schedule together in a way that hasn’t been for a long time and kind of retrain your body how to sleep again. And first thing that you need to do is to set up a schedule that kind of train your body to sleep at the same time each night and to wake up at the same time each day.

32 minutes 22 seconds DR. EDWARD J. STEPANSKI

[32:22] DR. EDWARD J. STEPANSKIThere is a biological clock that programs us when we’re supposed to be asleep or when we’re supposed to be awake, and I would suggest that your clock is a little mixed up right now. It’s not really quite sure, it’s like get some sleep here and get some sleep there unless I’m really tried then I can sleep over there, and I think that’s makes it hard for you to get a consistent pattern of really good deep sleep that it kind of depends on your what’s going on that day and just how exhausted you might be is to exactly when you hit the pillow and when you get to sleep and how things play out after that. So if we think that you need six hours of sleep then the idea would be will you be in dead for six and a half hours from beginning to end and that you’d have to take all the sleep that you’re getting and scrunch it together and force it into this one period of time and the question would be what schedule would you chose under those circumstances. The anchoring point of the circadian rhythm and biological rhythm for sleep your clock is time you get up because that’s the time you can absolutely control, you can’t control them and fall asleep at this exact minute. LEEANNE: Alright. DR. EDWARD J. STEPANSKI: That may or may not happen, but you can control that I can get up at this exact minute and I can do that seven days a week and so that is the way to try and to start getting everything under control, so you would want to chose a time that you can get up at that time seven days a week and from talking to you it sounds it would be at six, it would be at eight so it depends on exactly how the night went. LEEANNE: I like to be around 6:30. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: I would really work on 6:30.

33 minutes 52 seconds DR. EDWARD J. STEPANSKI

[33:52] DR. EDWARD J. STEPANSKIAlright. LEEANNE: Like this morning, I mean, I was up all last night again,

33 minutes 57 seconds LEEANNE

[33:57] LEEANNEbut I knew I forget to make my son’s lunch, so I consciously I mean I got up at 6:30, I was so tired, but I still got up and stayed up. See that’s my problem sometimes is I’ll get up to make a lunch or do something and then I’ll go up and go to bed and I’ve been trying not to do that, I’ve been trying to force myself to stay up and start functioning at that hour. DR. EDWARD J. STEPANSKI: And I’m impressed that a lot of things

34 minutes 27 seconds DR. EDWARD J. STEPANSKI

[34:27] DR. EDWARD J. STEPANSKIthat you’ve done are exactly the right things to do. The idea that you try to just not jump into bed and force yourself to fall asleep at sometime just because it’s 10 o’clock and I want to sleep. You wait until your body seem sleepy and then you turn off the TV and fall asleep and the other idea that once you’re up, you’re up, let’s just go ahead and keep going all day with the idea that next night you will be on track and you can get a better sleep at that point and that’s exactly the right thing to do. So if you want to get up at 6:30 and start your day than a 12 to 6:30 schedule would be more or less what I would be thinking about for you. The idea that by going to bed at 12, it’s going to be easier for you to get back to sleep when you wake up, again not that you won’t wake up at all, but that will be easy to return to sleep. It will also be easier to return to sleep if you didn’t go to the basement and around the entire house.

35 minutes 17 seconds DR. EDWARD J. STEPANSKI

[35:17] DR. EDWARD J. STEPANSKIOn the other hand, if you fell like that’s really going to be more than you can handle that will make you anxious not to do that then you can kind of do this in steps and starts with the schedule the 12 to 6:30 with the idea that once you check the house and made sure everyone is home and everything is safe you can go back to bed at that point. LEEANNE: Usually, I would be check if my son’s

35 minutes 37 seconds LEEANNE

[35:37] LEEANNEhome then if I’m going bed at midnight then I could do all that before I go to bed.

35 minutes 42 seconds DR. EDWARD J. STEPANSKI

[35:42] DR. EDWARD J. STEPANSKIYeah, and if that works and might be a reason even push it back even later and go to

35 minutes 47 seconds 12

[35:47] 1230 to seven or something if it means if there is a 90% chance that everything is set and you no longer have that to worry about that everything has been taking care of that you need to be concerned about because the idea is that you want your sleep time to be sacred time, relaxing time you don’t want to have anything else that you have to worry about between because it’s going to be counterproductive that if there is things that you know are left undone and things that have to be taking care of between your bed time and your rising time, you’re not going have your best night of sleep. LEEANNE: No. DR. EDWARD J. STEPANSKI: And there was a reason before why

36 minutes 22 seconds DR. EDWARD J. STEPANSKI

[36:22] DR. EDWARD J. STEPANSKIthat had to be, but may be now things are settling down a little bit and you can kind of get bother without so much of that at night and if the 12 o’clock bedtime helps in that regard then that’s a real good thing to do. So again it’s not that by reducing you’re taking at an extreme you might fall sleep at 11 and not be up to eight, so that’s a nine hour period of time and the idea is whether there is no way you’re ever going to sleep for nine hours. So by having a longer schedule, it just means it’s very very likely you’re going to be awake for hours during that time, so we want to just that wake time out of there and push other sleep together, not that you’re going to get less sleep than you get now. We expect you get the same and eventually more and it will be better sleep and you go through the sleep cycles on a more rhythmic typical manner as you’re supposed to and we will see what happens, we’ll see what happens with the dreaming, sometimes that the dreams that you describe can happen and that you’re waking up off and not that you’re just going to remember vivid dreams more than someone else sleeping soundly because if we sleep through the REM period and go back into non-REM.

37 minutes 27 seconds DR. EDWARD J. STEPANSKI

[37:27] DR. EDWARD J. STEPANSKIWe don’t remember dreams even if its 10 minutes after the REM period is over people won’t remember what happened if they wake up then, so people who wake up more often are much more likely to wake up and remember vivid dreams and it maybe that you have an idea where the dream woke me up, well, it may be that way or may also be that just what was happening at the time that you woke up and it’s not something that would wake you up in and of itself. So some of those things where we have to see what happens as you get your schedule on a little tighter and something that would be more comparable with what you really need to be doing with your sleep now.

38 minutes 2 seconds DR. EDWARD J. STEPANSKI

[38:02] DR. EDWARD J. STEPANSKII would also recommend that you not watch TV in the bedroom. I don’t know how hard that would be for you. LEEANNE: It wouldn’t. DR. EDWARD J. STEPANSKI: Okay, you know, watch it somewhere else in the house, if you can do that once it gets to be midnight then you go up to bed and get in the bed at that point feeling drowsy and give yourself a chance to sleep. If you’re wide awake and it’s been a half an hour or so you can get up and go watch TV again, but again watch it somewhere else. And the idea with this is trying to break this negative conditioning that’s occurred over all of these years and that is for people who are good sleepers, they look at their bedroom and they feel relaxed and they automatically start to get more and more drowsy. If you have not been sleeping very well, you don’t really have that and it can even go the opposite way where people kind of get into bed and they sort of wake up that this a place they spend a lot of hours and a lot of nights being wide awake and you don’t want that experience, you want to be in bed only when you’re asleep or when you’re drowsy and if you’re wide awake, you should just never be there, then you keep watching TV until it’s later just because we say 12 to

39 minutes 2 seconds 6

[39:02] 630, doesn’t mean you have to go to bed at 12. LEEANNE: Right. DR. EDWARD J. STEPANSKI: If you’re really wired, well then, wait till 12:30 and

39 minutes 7 seconds DR. EDWARD J. STEPANSKI

[39:07] DR. EDWARD J. STEPANSKIkeep your attention on something else because once you’re in bed and the TV is off and the lights are off, there really isn’t much to do if you’re wide awake other than worry and it’s not that the worrying necessarily keeps you awake, it’s that well that’s how you’re passing the time until your body relaxes sufficiently enough to cause you to go to sleep, so...(crosstalk) LEEANNE: It sometimes isn’t even worry,

39 minutes 27 seconds LEEANNE

[39:27] LEEANNEit’s what I’m going to go to do tomorrow. See, I think about what I’m going to, what is my job, what I’m going to be doing around the house tomorrow, what I need to do or, so it’s not always worry that keeps me up, it’s like my husband said if I can have one of those things across my head and you can see my wheels turning in my brain because my brain is always thinking about something, always, what I want do in the house, oh now that spring’s coming, I want to get out in the yard, which I’m really itching to do. So it’s not always bad things, it’s sometimes good things like I’m overanxious because we’re going to go out and see the kids out in Colorado, so that keeps me up sometimes because I’m so overanxious about doing that. DR. EDWARD J. STEPANSKI: Okay. Well, we’ll see how it goes because sometimes it can

40 minutes 17 seconds DR. EDWARD J. STEPANSKI

[40:17] DR. EDWARD J. STEPANSKIstart off as something like that and if you’re awake long enough with again nothing to focus on other than what’s going on in your mind, it can eventually go into direction like that actually increases you arousal level and increases your tension level, and for that reason, we might at some point also talk about teaching you relaxation exercises, things that you can do to put your mind in a more. neutral area and focus on, say on your breathing or something like that, that won’t cause you to become tense or become stimulated or aroused at that particular time when you don’t want to be. But very often people don’t need to do that to really get their sleep in much better shape and I think the first things that will be really good for you and also very challenging, is to get you schedule much more rigidly consistent with the rising time in particular, but forcing all of your sleep in the six and a half an hour period and maybe that will add to it and maybe that after a while we will find out that you do well on 12 to seven or this or that, but only once we get your sleeping extremely well between 12 and 6:30 and that and then making sure that you’re only in the bedroom when you are relaxed, drowsy, or asleep that those are two pretty big steps compared to the way things have gone for you the past 18 years and if you can accomplish those to start with, we can add on some other changes to your schedule and kind of troubleshoot whichever thing seems to giving you the most trouble at that time. Do these sound like things you can do?

41 minutes 42 seconds LEEANNE

[41:42] LEEANNEOh, I’ll try...(crosstalk) DR. EDWARD J. STEPANSKI: Okay. LEEANNE: I’ll just have to reverse my patterns and work on stuff around the house if I’m not tired, you know, things like that.

7: Homework

41 minutes 52 seconds LEEANNE

[41:52] LEEANNESo, no that would be absolutely no problem at all. DR. EDWARD J. STEPANSKI: Okay, good. And we would like you to engage in relaxing activities

41 minutes 57 seconds DR. EDWARD J. STEPANSKI

[41:57] DR. EDWARD J. STEPANSKIat night when it gets close to bedtime like after 10 o’clock, you probably don’t want to work on the computer...(crosstalk)

42 minutes 2 seconds LEEANNE

[42:02] LEEANNERight. DR. EDWARD J. STEPANSKI: At that point and not do things that we know will get you a little bit more revved up.

42 minutes 7 seconds DR. EDWARD J. STEPANSKI

[42:07] DR. EDWARD J. STEPANSKIThey have to be activities that take your attention and keep you occupied so you’re not just thinking about other things that might be more associated with tension and you’ll figure out kind of what those things are and I think you probably already have, to a large extent, you kind of know what things are intrinsically more relaxing for you and which things get you more revved up and make your sleep even worse.

42 minutes 27 seconds LEEANNE

[42:27] LEEANNEOkay. DR. EDWARD J. STEPANSKI: Okay, and then during this period, we will give you some sleep logs to fill up, so you can

42 minutes 32 seconds DR. EDWARD J. STEPANSKI

[42:32] DR. EDWARD J. STEPANSKIkeep track of exactly what kind of progress you’re making. Sleep is one of the things that tends to change very gradually, it’s not going to be instant like after all, if I keep on the schedule three nights then I should see this great progress. You might see good progress in three nights, but it might take two weeks to really see and that’s why we track it more to say well in these two weeks did I do better than I did it the two weeks before that and that’s much more telling. Any one night you can sleep great, you can sleep awful and it doesn’t really signifying how the program is going to go in general. LEEANNE: Okay. DR. EDWARD J. STEPANSKI: Okay. LEEANNE: Sounds good. DR. EDWARD J. STEPANSKI: Any questions?

43 minutes 7 seconds LEEANNE

[43:07] LEEANNENo, not at all. DR. EDWARD J. STEPANSKI: All right, we’ll then what have you fill up the sleep logs and be in touch with us in a week and

43 minutes 12 seconds DR. EDWARD J. STEPANSKI

[43:12] DR. EDWARD J. STEPANSKIsee how you’re doing? LEEANNE: Okay. DR. EDWARD J. STEPANSKI: All right, very good. Thank you. LEEANNE: Thank you.