Behavioral Management of Insomnia
Behavior therapy can help reduce the factors that disrupt sleep. Behavior programs that may help insomnia include stimulus control therapy, relaxation techniques, temporal control therapy and sleep restriction therapy. It is common to combine several approaches.
Stimulus control therapy helps to strengthen the connection of the bedroom with sleeping rather than with insomnia.
- The bedroom is to be used only for sleep and sexual activity. Eating, working, playing, and watching television are not allowed in bed.
- Go to bed only when sleepy. If unable to sleep after 15 to 20 minutes in bed, leave the bedroom. Return only when drowsy. Until drowsy, engage in restful activities such as reading with a dim light.
Relaxation techniques target issues that may cause insomnia.
- Exercises that tense and relax each muscle group help the muscles relax.
- Stressors may be decreased by meditation, in which thoughts are redirected towards pleasant topics.
Temporal control therapy promotes the routine of the sleep-wake schedule.
- Get out of bed at the same time each day.
- Avoid daytime naps.
Sleep restriction therapy seeks to increase the quality of sleep by limiting time spent in bed to sleeping only.
- Do not spend too much time in bed awake. For example, the amount of time spent in bed may be kept to 6 to 6.5 hours per night if your total sleep time is 6 hours nightly. The mild sleep deprivation that is allowed to develop is expected to increase your ability to sleep. Your time in bed is increased slowly by going to bed earlier until you are sleeping the amount of time that leaves you feeling rested.
Medicines to Treat Insomnia
- Hypnotic or sedating medicines may be used to treat sleep problems and may be helpful for short sleep problems caused by jet lag or acute stress. These medicines may also be prescribed for chronic insomnia.
- Barbiturates, chloral hydrate, antihistamines and some antidepressants, were all prescribed in the past. They have been replaced with newer and safer medicines. Antihistamines (many over-the-counter) are helpful for mild insomnia. Talk with your doctor before taking over the counter medicines for insomnia.
- Some sedating medicines may be used to treat insomnia. Short acting medicines are used for people who have trouble falling asleep. For people who can’t fall asleep quickly and wake up often, intermediate action medicines may be helpful. Long acting medicines are used for people who wake up early and have daytime anxiety.
Sedating medicines can cause side affects and should be used with caution.
- Long acting medicines may cause sleepiness the next day. This may be more noticeable among the elderly, and may contribute to accidents and falls.
- Caution must be used when operating motor vehicles or when performing tasks that require alertness.
- Insomnia may develop again if medicines are stopped quickly.
- Tolerance may develop with long-term use of medicines.
- Pregnant women and breast-feeding mothers should not take sedating medicines. People with liver or kidney problems may need to have their dosage adjusted. And, those with sleep apnea and chronic lung disorders should use caution, as sedating medicines may suppress breathing.