So far I have spent a lot of time reviewing the different medicines available for the treatment of insomnia. Today, we will touch on some non-pharmacologic (non-medicine) treatments. It is important to point out that the effects of different medications for insomnia are evident only when you are taking the medicines, not when you stop taking them. The non-medicinal treatment, however, "teaches" patients with insomnia how to get a good night's sleep. The effects of this instruction stay with the patient long after the actual treatment sessions have ended.
These non-pharmacologic treatments are usually performed by a psychologist who uses various methods to retrain the patient on their approaches to sleep. I will analyze a few of the more common methods below. (Much of this blog is adapted from a very good review article by Dr. Becker, Neurologic Clinics, November 2005.)
Stimulus control, or ‘‘the 10-minute rule''- Studies have shown that when patients who have difficulty falling asleep allow themselves only 10 minutes (20 minutes for the elderly) of waiting for sleep in bed, they have significant improvement in the amount of time it takes to fall asleep. If patients are not asleep in 10 minutes they are to get up, get out of bed, go into a different room, do non-stimulating activities (think about reading "War and Peace"), and return to bed only when they are good and sleepy. This process should be repeated as often as necessary until sleep comes on quickly when returning to bed. After 5-15 of these ups and downs, many patients start experiencing a rapid sleep onset.
Sleep restriction therapy- This one has been shown to be effective for all types of insomnia (difficulty falling asleep or staying asleep). Most people who have insomnia stay in bed for hours trying to fall asleep, with the belief that they need to be in bed to "catch" those few precious sleep moments that only sometimes occur. This process can be counterproductive because lying bed and not sleeping only feeds the insomnia and makes it worse (see my previous insomnia blogs for more on this concept). The thought on sleep restriction is to spend at least 85% of your time in bed actually sleeping. The total amount of sleep (usually taken from a sleep diary) per night is averaged over a week, and that is the maximum amount of time the patient spends in bed (as long as it is more than 4 hours). If 85% of that time is spent sleeping, then after a week 15 minutes extra of bed time is added. Though you may be very tired during the first week or two, most people start feeling that sleep is more consistent and deeper after the initial period.
Cognitive behavioral therapy (CBT)- It is fairly well-understood by sleep researchers that beliefs, attitudes, and poor sleep behaviors can make sleep worse in chronic insomniacs. CBT tries to help people realize that (1) they can function well even on reduced sleep, (2) they sleep more than they realize, (3) they can manage the stresses of the day, and (4) they must become responsible for their thoughts of the day, so that sleep can improve. These techniques have been shown to help both the young and the elderly, and as noted above may even have more long-lasting effects than medications alone.
Relaxation therapy and imagery- Psychologists train the patient on effective means of relaxing themselves when they are trying to fall asleep. The key to the success of this technique is practice, and it is often helped by adding pleasant imagery (such as thinking that you are lying on a quiet beach) to your thoughts. After suffering for a long time, chronic insomniacs hope for immediate relief, but this and most of the other techniques I've described take a little time and patience before they start to work. But don't be discouraged, the results are encouraging, especially when supervised by a psychologist experienced in treating sleep disorders.
Published On: August 21, 2007