Kid strategy of the week:

Bedtime routine: Starting healthy sleep habits in childhood/adolescence can facilitate better sleep hygiene as kids age. One helpful sleep strategy that kids can do is create a bedtime routine.

During the session, create a bedtime checklist or poster by:

• Identifying five or six activities they can do each night (such as, clean up, bath/shower, pajamas, brush teeth, goodnights, bathroom, story time, hugs, sleep!)
  • These can also include activities that make a bedroom “sleepy” (temperate changes, lighting, blankets, smells, noise machine)

Source: https://www.sleepfoundation.org/children-and-sleep/sleep-strategies-kids

Sample Progress Note: The focus of the session was (tailor based on treatment plan). The therapist engaged the client in developing a bedtime routine checklist/poster to help them build healthy patterns and habits for sleep. The client responded to the sleep hygiene activity by (fill in the blank).

Couples strategy of the week:

Bedtime ritual: Developing a ritual before going to sleep each night can generate a sense of consistent connection within a relationship. Whether or not the couple goes to sleep at the same time, a habit of connecting can foster deeper meaning each day.

Here are some ideas of nightly rituals to explore with couples:

• As the first person goes to bed, end the day with a hug and/or forehead kiss
• Come up with a goodnight phrases
• Share something you are grateful for from that day
• Express appreciation for something the other did that day or overall about them
• Engage in 7 breath-forehead exercise
• Hold hands for a time before falling asleep

Source: https://www.gottman.com/blog/3-daily-rituals-that-stop-spouses-from-taking-each-other-for-granted/
Sample Progress Note: The focus of this session was… The therapist helped the couple create a bedtime ritual to promote consistent connection in their relationship. The couple was (engaged/receptive/disengaged/etc) while participating in the activity, and they (were able/struggled/somewhat able) to identify ways of connecting with meaning at the end of each day.

Adult strategy of the week:

Follow a nightly routine: Amid all of life’s activities and stressors, sleep is essential to maintaining resilience, feeling vitality day to day, and staying healthy overall. Talking about sleep hygiene and promoting consistency at bedtime are two places to start in developing helpful sleep habits.

• Start by identifying a regular bedtime range (within 1-2 hours each night if possible)
• Then develop a routine of five to 10 activities that begin 30-60min before bedtime (cuing the brain it is time for sleep!)

• • Lower lights
  • Slightly reduce temperature in bedroom
  • Put on softer music and/or turn on sound machine
  • Light a candle and/or spray soothing scent in bedroom
  • Change in to sleep attire
  • Brush teeth/hair, etc.
  • Use calming scented lotion
  • Turn off screens/devices
  • Stretch, meditate, progressive muscle relaxation
  • Acknowledge three things you are grateful from the day

Source: https://www.therapistaid.com/worksheets/sleep-hygiene-handout.pdf
Sample Progress Note: The focus of this session was… The therapist helped the client develop a nightly routine to build helpful sleep hygiene practices. The client reported that creating a bedtime ritual was (helpful/not helpful/boring/etc), and the client expressed that they are (likely/not likely) to engage in the nightly routine in the future.

Mindfulness/Meditation of the week:

Progressive Muscle Relaxation: PMR has been shown to improve one’s ability to both fall and stay asleep, along with reduce tension and stress within the body. It can be helpful to guide clients in a PMR exercise a few times to support them in developing this skill in their own nightly practice.

Sample Progress Note: The focus of this session was… The therapist led Ct. in a progressive muscle relaxation exercise to build helpful sleep hygiene practices. Ct. (engaged/did not engage in the activity), and they reported that the PMR exercise was (helpful/difficult/not helpful)

Progressive Muscle Relaxation Script:

• Progressive muscle relaxation is an exercise that relaxes your mind and body by progressively tensing and relaxation muscle groups throughout your entire body. You will tense each muscle group vigorously, but without straining, and then suddenly release the tension and feel the muscle relax. You will tense each muscle for about 5 seconds. If you have any pain or discomfort at any of the targeted muscle groups feel free to omit that step. Throughout this exercise you may visualize the muscles tensing and a wave of relaxation flowing over them as you release that tension. It is important that you keep breathing throughout the exercise. Now let’s begin.
• Begin by finding a comfortable position either sitting or lying down in a location where you will not be interrupted. Allow your attention to focus only on your body. If you begin to notice your mind wandering, bring it back to the muscle you are working on. Take a deep breath through your abdomen, hold for a few second, and exhale slowly. Again, as you breathe notice your stomach rising and your lungs filling with air. As you exhale, imagine the tension in your body being released and flowing out of your body. And again inhale…..and exhale. Feel your body already relaxing. As you go through each step, remember to keep breathing .
• Now let’s begin. Tighten the muscles in your forehead by raising your eyebrows as high as you can. Hold for about five seconds. And abruptly release feeling that tension fall away. Pause for about 10 seconds. Now smile widely, feeling your mouth and cheeks tense. Hold for about 5 seconds, and release, appreciating the softness in your face. Pause for about 10 seconds. Next, tighten your eye muscles by squinting your eyelids tightly shut. Hold for about 5 seconds, and release. Pause for about 10 seconds.
• Gently pull your head back as if to look at the ceiling. Hold for about 5 seconds, and release, feeling the tension melting away. Pause for about 10 seconds.
• Now feel the weight of your relaxed head and neck sink. Breath in…and out. In…and out. Let go of all the stress In…and out. Now, tightly, but without straining, clench your fists and hold this position until I say stop. Hold for about 5 seconds, and release. Pause for about 10 seconds.
• Now, flex your biceps. Feel that buildup of tension. You may even visualize that muscle tightening. Hold for about 5 seconds, and release, enjoying that feeling of limpness. Breath in…and out. Now tighten your triceps by extending your arms out and locking your elbows. Hold for about 5 seconds, and release. Pause for about 10 seconds.
• Now lift your shoulders up as if they could touch your ears. Hold for about 5 seconds, and quickly release, feeling their heaviness. Pause for about 10 seconds. Tense your upper back by pulling your shoulders back trying to make your shoulder blades touch. Hold for about 5 seconds, and release. Pause for about 10 seconds.
• Tighten your chest by taking a deep breath in, hold for about 5 seconds, and exhale, blowing out all the tension.
• Now tighten the muscles in your stomach by sucking in. Hold for about 5 seconds, and release. Pause for about 10 seconds.
• Gently arch your lower back. Hold for about 5 seconds, relax. Pause for about 10 seconds.
• Feel the limpness in your upper body letting go of the tension and stress, hold for about 5 seconds, and relax. Tighten your buttocks. Hold for about 5 seconds…, release, imagine your hips falling loose. Pause for about 10 seconds.
• Tighten your thighs by pressing your knees together, as if you were holding a penny between them. Hold for about 5 seconds…and release. Pause for about 10 seconds.
• Now flex your feet, pulling your toes towards you and feeling the tension in your calves. Hold for about 5 seconds, and relax, feel the weight of your legs sinking down. Pause for about 10 seconds.
• Curl your toes under tensing your feet. Hold for about 5 seconds, release. Pause for about 10 seconds.
• Now imagine a wave of relaxation slowly spreading through your body beginning at your head and going all the way down to your feet. Feel the weight of your relaxed body. Breathe in…and out…in…out….in…out

Source: https://www.law.berkeley.edu/files/Progressive_Muscle_Relaxation.pdf