When it comes to the best treatment option
for insomnia, there is a ton of conflicting information out there.
I see plenty of bad advice handed out to people
suffering from insomnia and I see many so-called insomnia cures that have
little (or no) evidence on their safety or effectiveness get recommended on a
regular basis.
Let's change all that, starting today.
The American Academy of Sleep Medicine conducts
comprehensive reviews of scientific literature on a periodic basis to help
determine which insomnia treatments actually work.
Want to know how to cure insomnia? Continue reading!
Listed below are the insomnia treatments that have been comprehensively
reviewed and graded by experts appointed by the American Academy of Sleep
Medicine.
Legend
Standard recommendation; a generally accepted
strategy with a high level of clinical certainty.
Guideline; a strategy with a moderate
degree of clinical certainty.
Uncertain clinical use; inconclusive or
conflicting evidence or expert opinion.
Cognitive behavioral therapy (CBT)
CBT combines cognitive and behavioral
techniques to improve sleep. CBT addresses incorrect thoughts, beliefs, and behaviors towards sleep.
These are often the root cause of many cases of insomnia .
Cognitive behavioral therapy for insomnia usually
includes a combination of sleep education, stimulus control therapy, sleep
restriction, relaxation training, and sleep hygiene education.
You can learn more about CBT in my free two week insomnia sleep training course.
Relaxation training
Relaxation techniques help reduce the
mental arousal that can make sleep difficult. This mental arousal is sometimes
described as a racing mind.
Relaxation training includes:
·
Guided imagery
·
Abdominal
breathing
·
Progressive
muscle relaxation
Progressive muscle relaxation involves
tensing and relaxing muscles throughout the body in a methodical fashion. There
are many ways to do this. Here's one method:
1.
Lie in bed
with the lights off
2.
While breathing
in, tense the muscles in your toes for about five seconds
3.
Quickly release
the tension and breathe out
4.
Relax for about
30 seconds. Feel the looseness in your relaxed muscles and notice how different
they feel compared to when they were tensed
5.
Repeat one
more time or move up the body to another muscle group (such as your calves) and
repeat the process
6.
Continue until
you reach the top of your body
Stimulus control therapy
This technique helps to associate the bed with sleep
(not wakefulness) and converts negative associations into positive ones.
Stimulus control involves:
·
Avoiding
daytime naps
·
Only going to bed
when sleepy
·
Keeping a
regular sleep/wake schedule
·
Getting out of
bed if you can't fall asleep
·
Using the bed
for sleep and sexual activity only
You can learn more about stimulus control in my free sleep training course for insomnia.
Multicomponent therapy
This uses various components of CBT, but not all of
them. For example, multicomponent therapy may include stimulus control, relaxation
training, and sleep hygiene education — but not sleep restriction.
Sleep restriction
Although commonly referred to as sleep
restriction, I prefer to use the term restricting time allotted for
sleep in order to avoid the common misperception that sleep
restriction reduces sleep duration. It doesn't!
This technique involves reducing the amount of time
spent in bed to more closely match the amount of sleep you're getting. It is
designed to increase sleep pressure, increase sleep duration, and help you
associate the bed with sleep — not wakefulness.
To try this technique, you'll need to keep a sleep
diary for at least a week. Every day, write down the time you went to bed the
previous night, the time you got out of bed in the morning and how many
hours of sleep you got.
The aim here is to make sure you do
not spend more than an hour over your nightly sleep duration in bed .
Here's an example:
|
Day: |
Monday |
Tuesday |
|
Bed time: |
11pm |
10.30pm |
|
Out of bed time: |
6am |
7.30am |
|
Hours of sleep: |
5 hours |
5 hours |
|
Total time in bed: |
7 hours |
9 hours |
For
the sake of brevity, I've only used two days in the example above. You
should keep a sleep diary for at least a week if you want to try this
technique.
In the example above, we can see that - on
average - this individual is allotting eight hours for sleep each night ( (7+9)
/ 2 ). Yet, they are only averaging about five hours for sleep each night (
(5+5) / 2 ).
Adding one hour to their average nightly sleep
duration would mean allotting about
six hours for sleep each night. This would be a more appropriate amount of
time to allot for sleep.
This individual should now write down when they want
to get out of bed each morning, deduct six hours from that time, and they have
their new regular bedtime.
The amount of time you allot for sleep should not be less than five-and-a-half
hours.
This amount of time allotted for sleep can be
increased by half an hour each week as long as sleep efficiency remains
above 85%. Sleep efficiency is measured by dividing sleep duration by time
allotted for sleep, and multiplying by 100.
For example, if I spend seven hours in bed and get six
hours of sleep, my sleep efficiency is 85.7%.
Paradoxical intention
The insomnia remedy that many haven't
heard of, paradoxical intention therapy involves
confronting the fear of insomnia by trying to remain awake, but relaxed.
This addresses the 'performance anxiety' suffered by
many insomniacs who struggle to fall asleep.
Biofeedback
Biofeedback uses visual or audio feedback
to help reduce arousal.
Sleep hygiene as a single therapy
It's important to note that sleep hygiene
only comes without a recommendation when used as a single treatment
strategy .
Sleep hygiene is a form of behavioral intervention
that teaches individuals about lifestyle practices that impact sleep. It should
be combined with other techniques such as sleep restriction, cognitive therapy,
and stimulus control.
Sleep hygiene techniques include:
·
Eating a
healthy diet
·
Getting regular
exercise
·
Keeping a
regular sleep schedule
·
Exposure to
natural light in the day
·
Avoiding
caffeine and other stimulants
·
Keeping the
bedroom cool, dark, and quiet
·
Avoiding
exposure to artificial light at night
My free sleep training course goes into more
detail about sleep hygiene.
Imagery training as a single therapy
As with sleep hygiene, this technique only comes without
a recommendation when used as a single treatment strategy.
Imagery training involves visualizing pleasant or
neutral images with the aim of blocking out unwanted thoughts before sleep. The
theory behind this is it can help promote relaxation and calm a racing mind
before bed.
Cognitive therapy as a single therapy
Cognitive therapy is not the same as cognitive
behavioral therapy. Cognitive therapy only aims to address incorrect thoughts,
beliefs, and attitudes towards sleep. Unlike cognitive behavioral therapy, it
does not specifically target the behaviors that influence sleep.
Cognitive therapy, when used
within cognitive behavioral therapy, is effective and comes with a
recommendation . Cognitive therapy as a single therapy does not.
Sleeping
pills
The following are consensus-based recommendations and
reflect the shared judgement of an expert insomnia panel assembled by the
American Academy of Sleep Medicine:
·
Short-term
hypnotics should be supplemented with behavioral and cognitive therapies
·
Those taking
sleeping pills long-term should receive an adequate trial of cognitive
behavioral therapy
·
Over-the-counter
antihistamines/analgesics and herbal/nutritional substances such as valerian
and melatonin are not recommended for chronic
insomnia due to lack of data on their safety and effectiveness
If you are struggling with sleep, speak to your
doctor. Don't blindly follow the advice of others without doing your due
diligence first!
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