Although medications can help people with insomnia to sleep, they cannot cure the condition. In addition, behavioral methods act faster. Behavioral methods work for all age groups, including children and elderly patients.
Behavioral methods include:
- Stimulus control
- Cognitive behavioral therapy
- Relaxation training and biofeedback
- Sleep restriction
All behavioral approaches have the same basic goals:
- To reduce the time it takes to go to sleep to below 30 minutes
- To reduce wake-up periods during the night
Studies report that 70 - 80% of patients who are treated with non-drug methods experience improved sleep. Furthermore, 75% of those who have been taking drugs are able to stop or reduce their use.
Stimulus Control. Stimulus control is considered the standard treatment for primary chronic insomnia and may be helpful for some patients with secondary insomnia as well. The primary goal of stimulus control is to regain the idea that the bed is for sleeping. It involves the following:
- Go to bed only when ready to sleep or for sex.
- If unable to sleep within 15 - 20 minutes, get up and go into another room. (People who find it physically difficult to get out of bed should sit up and do something relatively arousing, like reading a book.)
- Maintain a regular wake-up time no matter how few hours you actually sleep.
- Avoid naps.
Cognitive-Behavioral Therapy. Cognitive behavioral therapy (CBT) is a form of therapy that emphasizes observing and changing negative thoughts about sleep such as, "I'll never fall asleep." It uses actions intended to change behavior. The goal is to change or correct misconceptions about the ability to fall and stay asleep. Emphasis is on reinforcing the need for 7 - 8 hours of sleep each night and addressing the anxiety that patients with insomnia often develop around sleep. Several studies have shown it to work as well or better than drugs. According to several studies, adding medication to CBT does not provide additional benefit.
Review Date: 06/11/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.