Problem
Molly Conrad is a freelance personal chef and a contributing writer for several regional food magazines.
"My life revolves around food," Molly jokes. "And I mean my whole life: my conversations, the books in my home, the TV shows I watch; even my bed revolves around food!"
"Uh oh," Adam, her consulting advanced practice nurse at the sleep clinic teases her back. "I guess if your bed revolves around food that might be contributing to your sleep problems?"
"Absolutely," Molly says. "I know it does." Molly tells Adam, "I think my insomnia started because of my freelance work challenges. I don't have a nine-to-five job. Instead, everything depends on my clients' needs and schedules. I have to be on when they need my services-or good luck paying the gas bill, you know?"
Adam asks Molly to describe more specifically how she believes work has affected her sleep negatively over the past 7 days.
"Did you keep your sleep diary this week?" he says.
"Yes," she says. "I did!" She hands over several notebook pages to Adam. He doesn't read very far before he's smiling and nodding.
Here are Molly's sleep diary pages:
Monday and Tuesday: I didn't have any work, which always makes me panic a little. I tried to fill the day by trying out a few new recipes, and then fell asleep both days for 2 hours in front of one of the food networks on TV. Tuesday night, I really tried to go to bed early. I was in bed by 8:30, but I just tossed and turned and stared at the ceiling for over an hour, so I grabbed the remote and watched a couple of DVDs. I was just too pent up, I guess, to go to bed that early.
Wednesday: Today I got two calls for catering! EEEK!! One is for a late-night bachelorette party on Friday night, and the other is for a men's prayer breakfast at the Methodist Church on Lake Drive. So Wednesday night, I tried to get a good night's sleep, but I was too wound up about two big jobs, so I got up and thought I might as well be productive, so I went to the computer, which is there in my bedroom and typed out both menus. I fell back asleep about two in the morning.
Thursday: I got up early today because I had tons of shopping to do for the party and the prayer breakfast. Came home, put all the food away in two fridges, crashed on the couch to watch the Julia Child movie for inspiration, and slept through the whole movie. I woke up to the phone ringing. The call was from a guy wanting to surprise his wife, who has just had a baby, with a week's worth of dinners in their fridge. I met him at a coffee shop on his way home from work (so his wife wouldn't find out), and we made up the menu, and I gave him an estimate. He wants a Sunday afternoon delivery, but I told him my license says I have to cook on the premises, in their home, so we made a date for Saturday. I'll walk in and surprise her by wearing my chef's uniform and hauling in all my pots and pans. He says she's going to cry! (I will too if I don't get a good night's sleep tonight.)
Thursday Night: Not much luck on the sleep front. I was all wound up about my three big events. After grabbing a snack, I ended up crawling back into bed with the laptop to work out final details of my cooking schedule. Fell asleep with the laptop. It was maybe three.
Friday: I cooked all day for both parties. I felt myself practically falling asleep in the cheesecake batter. Friday night, they didn't start eating till, like, 9 PM, so by the time I cleaned up and went home, it was 11:30 PM. I always have to unwind before I go to sleep, so I watched TV in bed, and fell asleep about midnight, which was good, but I woke up about 1:30 AM with the TV blaring. I got up and grabbed my laptop and went over my food prep for the men's breakfast tomorrow. I have 3 hours left to sleep before I need to get to the church and start the Belgian waffles. I wish I could cancel the young dad and his wife, but I can go days between contracts, so I'll just have to gut it out this week.
Task
Question I
Molly asks Adam, "Now that those contracts are all over, I can relax and catch up on my sleep for a few days. My best friend takes a hypnotic medication. Do you think I could have a prescription?" What is Adam's best response?
Question II
As Adam makes a diagnosis and treatment plan with Molly, he uses her sleep diary as a teaching tool. Keeping in mind that Adam is using the stimulus control approach, what clues to her problems can we glean from Molly's diary?