Treating sleep problems can be challenging. There are a variety of treatments that can help. Some of these include cognitive behavioral therapy, relaxation or meditation techniques and sleep education. Other options include sleep restriction and melatonin supplements.
If these therapies are not helpful, some psychiatric medicines may be used for a short time. These should be taken only under a doctor’s supervision because they can have side effects.
Cognitive behavioral therapy (CBT)
Cognitive behavioral therapy can be effective in treating long-term sleep problems like insomnia. It is safe and usually the first treatment recommended for people who have difficulty sleeping. It can be conducted in a therapist’s office, online or on your phone.
In CBT, you learn to identify thoughts and beliefs that contribute to your sleeping difficulties. A therapist will help you challenge and change these negative thoughts and attitudes. For example, a person with insomnia might believe that not getting enough sleep will cause them to feel tired the next day. This belief can be challenged by analyzing the logical basis of this thought pattern and evaluating whether it is accurate.
CBT also teaches you healthy behaviors for sleep, such as developing a regular sleep schedule and eliminating naps. This is a great alternative to medication and is especially useful for people who work or drive, have medical conditions that prohibit the use of sleep aids or take medications that interfere with good sleep.
Stimulus control
Stimulus control is a behavioral treatment for insomnia. It is a core component of CBT and is effective in decreasing sleep initiation difficulties. However, it does not appear to be effective in improving other important outcomes like night-time symptoms and daytime functioning. It is recommended that more research be devoted to exploring the efficacy of stimulus control in clinical trials.
SCT combines multiple techniques that help you modify simple habits and thoughts in order to promote healthy sleeping patterns. These include sleep hygiene education, stimulus control counseling, and relaxation training. The goal of stimulus control is to break the learned association between bed and sleep. This can be accomplished by limiting the time you spend in bed and getting out of bed when you cannot fall asleep.
Remaining passively awake
Many health conditions can interfere with sleep, including arthritic pain and medications that cause drowsiness. These comorbidities are common in older adults and may impact sleep quality.
A cognitive behavioral therapy treatment called paradoxical intention can help reduce conditioned responses to bedtime. It works by encouraging patients to lie passively in bed without worrying about falling asleep. It can also help relieve performance anxiety that prevents good sleep.
If you have trouble sleeping at night, talk to a therapist about it. Online therapy can be an option if you are too busy to travel or take time off work for in-person sessions. In addition to helping you cope with sleep disorders, a therapist can offer support for other mental health issues. This is especially important for older adults.
Sleep restriction
It may seem counterintuitive, but one of the cornerstones of CBT-I is sleep restriction. It involves setting a firm wake-up time and limiting how long you can spend in bed each night.
This builds homeostatic sleep drive (the desire to sleep), which helps people fall asleep faster and wake up fewer times during the night. It also resets the circadian rhythm and allows the person to follow their natural sleep-wake cycle.
Patients will initially feel more tired during the day, due to the mild sleep loss, but this will improve as they get better at sleeping. As they start to sleep better, their therapist will gradually increase the amount of time they can spend in bed each night, usually in 15- to 30-minute increments.
Sleep hygiene
Sleep is an important part of good health, and is critical to the normal functioning of the brain and body. But poor sleep patterns can be caused by a wide variety of things, including stress, anxiety and chronic health conditions such as asthma, acid reflux, cancer and fibromyalgia.
Sleep hygiene is a psychoeducational intervention that identifies habits that influence sleep quality. It includes recommendations such as avoiding caffeine and alcohol, maintaining a consistent sleep-wake schedule, limiting napping, and ensuring that the bedroom environment is conducive to sleeping.
However, research is limited and inconclusive with respect to the efficacy of sleep hygiene as a standalone treatment for insomnia or any of the phenotypes/subtypes of insomnia. In addition, the underlying issues causing insomnia (such as depression and/or anxiety) can also be addressed through psychotherapy.
