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Signs of Covert Nonadherence Suggested Prevention Strategies Refusing to speak Mouth check Moving the tongue inside the mouth Liquid medications or water “chasers” Quickly turning away Officer observation and intervention Leaving for the restroom Restroom restriction Diverting to inmates in line or near Restrict inmate-to-inmate contact in pill line Unwillingness to show hands Preload pills into a cup to hand to patient Do not worry about an occasional sleepless night. Even persons who sleep only a couple of hours can function the next day. You will probably sleep better the following night. Stick to a regular schedule of sleeping and waking. Go to bed at the same time, and wake up at the same time regardless of the amount of sleep you had the night before. It may help to plan your sleep and wake schedule around a regular event such as counts, mess, or pill call. Do not nap during the day. If you nap during the day, you reset your sleep “clock,” and your body may not be ready to sleep when it is supposed to be. Exercise and other activities during the day will prepare your body to sleep at night. Exercise within 3 hours of sleep can keep you up, though. Eat a healthy diet. Do not drink caffeinated beverages (such as coffee, tea, or dark sodas) after noon. Some foods like chocolate may also contribute to sleeping trouble. Avoid heavy meals before bedtime. If you are hungry, a light snack may help you fall asleep. Do not drink a lot of liquids before going to sleep. You may have to wake up to urinate and may not be able to return to sleep. Develop a relaxing sleep ritual you perform 30 minutes before going to bed (such as reading). Do not get involved in emotional issues immediately before going to bed. As much as possible, turn off lights at night, keep your cell cool, and keep your cell quiet. If the lighting in your cell bothers you, consider covering your eyes with a clean piece of fabric (such as a sock or a wash cloth). If your cell is too warm, use a fan. During the day, expose yourself to as much light as possible. If you have a cellmate, agree about quiet hours when radio or television will be turned off, or used with headphones. Do not lie in bed unless you plan to sleep. Use the bed only for sleeping, unless other activities (like reading) are part of your sleep ritual. Do not try to make yourself sleep. If after 30 minutes in bed you are unable to sleep, get out of bed and do something relaxing. Do not return to bed until you are sleepy. Be aware that other medications (such as opiates, steroids, some antidepressants, interferon) and medical problems (such as chronic pain, asthma, peptic ulcer disease) may also interfere with sleep. Ask the provider prescribing medications for your medical or mental health problems if these problems or the medications you are taking may be a factor in your difficulty sleeping. If the above do not work, try sleep restriction. Add up the total number of hours you sleep per day, then allow yourself to remain in bed only for that many hours each night. Another approach is paradoxical intention, which is doing the extreme opposite of what one wants or fears. For example, instead of going through activities leading to sleep, prepare for staying awake and do something energetic. Or, if worry is a factor in sleeplessness, force yourself to worry excessively. Getting emotional support and expressing your feelings may reduce stress, and help you to sleep. Depression happens to a lot of people behind bars. Helping you feel better is an important goal of your treatment team. YOU are part of this team, and there are plenty of things you can do between appointments to help feel better. You may not be able to do all of these things, but even doing a few of them will help. It will help to start your day by planning to do something you usually would enjoy. Increase your physical activity Unless your doctor says no, try walking, jogging, or sports. If you already do these things, try doing them more. Plan to do things you can enjoy Read a book. Watch a movie or a favorite television program. Write a letter. Call a friend or family. Plan a visit. Play a game. Write about your feelings in a private journal. Do more to relax Take a shower. Listen to music. Meditate. Breathe deeply. Go to the yard for fresh air. Participate in your treatment plan Take medication as directed, if prescribed by a doctor. Attend all assigned individual and group therapy sessions. Stay busy Staying busy is good for your self-esteem. If you are on a work detail, do the best job you can do. Keep your cell neat and clean. Help someone else. Good sleep habits Have regular sleep and wake times; avoid napping during the day. Avoid caffeine and chocolate, especially after noon. Quit or cut back on cigarettes. Do not lie in bed except to sleep. Avoid exercising, eating, or drinking a lot of fluids just before bed. Avoid sleeping pills. Eat healthy foods Avoid junk food. Eat more fruits and vegetables. Do not use alcohol or drugs. Spirituality If it is your tradition, pray, read scripture, and attend religious services. If it is not, think about the people, ideas, and things that are important to you and give your life meaning.
