Answer

Behavior Management: Program to Increase Sleep Time to 8 hours

Abstract

This work details a program for achieving behavioral change, more precisely improving sleeping time from a baseline of 6 hours to 8 hours a night. The program was embarked on upon realization of the adverse effects of insufficiency of sleep, which have been documented in literature. Starting with efforts to sleep 30 minutes earlier by end of the first week, efforts were made to improve on this to achieve an improvement of 1 hour by the second week. A further improvement by the same margin saw realization of the goal by end of the fourth week.

Introduction

Having enough sleep daily is recommended as a general rule for good health. Indeed, as Chattu et al. (2018) observe, “a considerable body of evidence suggests that insufficient sleep causes hosts of adverse medical and mental dysfunction” (p. 1). Some of the problems that have been linked to insufficient sleep include cardiovascular disease, hypertension, diabetes, cerebrovascular disease, septicemia, malignant neoplassm, accidents, and poor performance at work as well as at school, just to mention but a few ( Chattu et al., 2018; Kochanek et al., 2013). In a broader context, insufficient sleep is linked to an elevated risk of premature mortality. A study found out that individuals sleeping less than 6 hours a day were at a higher risk (ten times more) of dying prematurely than those who were able to sleep between 7 to 9 hours a day (Hafner et al., 2016).

Reinforcement in the context of having enough sleep can be conceptualized in terms of the activities that one engages in that lead to sleeping late or cause psychological turmoil that makes one not get sleep, even when there is early retiring to bed.  Thus, a good approach is to avoid or reduce such activities, for example playing PS, as much as possible. Some of the immediate consequences of increasing sleep time will be missing out on gaming, extended nighttime with family/friends, and less TV time. The positive effects of enough sleep include better academic and work outcomes, safety (related to risk of accidents), and better health (Owens et al., 2014). Considering that these positive outcomes are not necessarily immediate, the sought behavior change will be effected with the knowledge that the said benefits will be long-term. More importantly, effort and consistency will be required if the behavior is to be maintained and the benefits derived.

The problem of insufficient sleep is not taken seriously by the general public, yet it has such grave consequences in terms of adverse health effects. Many people do not think that lack of sleep can contribute to challenges in the broader life picture. As such, one of the reasons people fail to get sleep enough is because this issue is not taken seriously as a health concern. Thus, people who are in the habit of not sleeping enough are not even aware of the seriousness of the issue, so it mostly underreported. According to Hafner and colleagues (2016), efforts to have enough sleep time fail due to failure to set predictable time for waking up, overusing or addiction to electronic gadgets such as phones prior to sleeping, and lack of enough physical exercise. With a clear goal to increase sleep-time set, an individual should pay attention to these impediments and address them appropriately, that is set clear wake-up time, avoid using electronic gadgets as much as possible prior to normal time of going to bed, and engaging in enough physical exercise. Reinforcers in such an undertaking ought to be more intrinsic, with an acute awareness that having enough sleep will bring one a wide range of health benefits in the long term. Policy makers ought to come up with necessary educative and awareness programs that would raise awareness and enlighten the public about the significance of having enough sleep-time.

Methods

I was the subject/participant in this project. I had been going to bed not earlier than midnight and waking up as early as 6 in the morning. This implies I had been sleeping for an average of about 6 hours. This was going to be the baseline for my behavior changing project, with an objective to achieve 8 hours of sleep-time.

As I embarked on this program, I identified a stimulus condition to help me achieve my goal. This was my elder brother who at the time had been staying up late studying for his upcoming Certified Accountants examinations. I told him about my program and goal so he could remind me when he thought it was time for me to sleep. Next, I set a specific time frame for realizing the behavior change I was seeking. I decided that at least in four weeks I should have adjusted my sleep-time from a baseline of 6 hours to 8 hours.

To succeed in my program, I knew it was imperative to comprehend contextual motivators and barriers. As per the Designing for Behavior Change (DBC) model (Schmied, 2017), this simply meant understanding what was preventing me from having enough sleep time and what could encourage me to change my behavior in the same respect. I conducted a Barrier Analysis (BA) and noted that playing PS, watching movies, and chatting on my phone were some of the barriers preventing me from having enough sleep time. As to motivators, I conducted short surveys asking peers and relatives about having enough sleep, and many spoke of the advantages, mostly related to health and educational performance. These benefits, hence, the general perception about having enough sleep, would be the source of my motivation.

Since I had been sleeping not earlier than midnight, my body was accustomed to this so shifting from that was going to be a gradual process. I set out to go to bed earlier by 30 minutes by the end of the first week, 1 hour by end of second week, and 1 and a half by end of the third week. That meant an improvement of 30 minutes weekly. Doing this meant scaling down significantly on the activities I identified as the main barriers. If for one reason or another I stayed up beyond the stipulated time for a given day, I would set the alarm to wake up slightly late than usual, more precisely by half an hour.

Results

I am glad to report that at the end of week three I was going to bed at 10.30 p.m. and waking up at 6.30 a.m.; I had achieved by desired behavior change! My else brother was very helpful because whenever he saw me with my laptop or with my phone and bedtime was approaching, he would remind me it was time to sleep. Since he was staying up late revising for his exams, he always made sure I went to bed before locking himself in the study room adjacent to my bedroom. However, there were about 3 days in the second week that he was not home and in as much as I went to bed at the stipulated time, I had my phone with me, and I was tempted to use it. Fortunately, I had a punisher for this: I did not take breakfast the following morning if my phone made me stay up late. The following table shows my sleep- and wakeup-times for the three weeks the program ran:

On days 3, 4, and 5 of the second week, my brother was not at home and, as seen in the table, I did not stick to the stipulated time of sleep. I was not disciplined enough to avoid going to bed with my phone. However, with the return of my brother, we discussed what I was trying to achieve and the benefits that lay ahead. Following that discussion, I was back on track and did not backslide till the end of my program. I was sleeping comfortably for 8 hours by the end of the third week.

Discussion

Embarking on this program was not easy because my body had been accustomed to having less sleep, that is, staying up late and waking up early in the morning. The presence of my brother acted as a stimulus condition because his constant reminders about why I needed to go to bed at the stipulated time helped me a lot. Admittedly, I would not have succeeded as much without him, a fact that is clear from my sleep patterns when he was not at home. In this program, I must emphasize that identifying barriers to my desired behavior change was helpful because by so doing, I was keen on what to avoid. Activities like watching, chatting, playing PS, and others that kept me awake late into the night are some of the barriers, which I did appreciably well to avoid, or at least reduce more so prior to going to bed. This entailed contextual negative reinforcement which, according to Sprouls and colleagues (2015) is equally as useful as positive reinforcement.

The main reinforcers for this program were the perceived benefits of having enough sleep. While most of this would not be realized immediately, some such as being alert and fresh with no mental exhaustion were visible during my day-to-day activities. I also noted I paid more attention to my social relations and was more active in class group discussions than I had previously been. This aspect helped me get a connection between enough sleep and improved academic performance.

Despite the success of my behavior change program, one limitation which I thought might have affected my results was the fact that going to bed and noting the time I was in bed did not necessarily mean I fell asleep that time. For instance, I could go to bed at 11:30 but still stay awake for 20 or so minutes before falling asleep. In such a case, my sleep time would still be 11:30. In fact, this limitation affects all noted times because one never knows the exact time he or she falls asleep. Nevertheless, it was an exciting undertaking and a personal challenge as to some of the things I ought to be doing to improve myself.

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