People often have chronic insomnia because of learned behaviors and patterns that are getting in the way of good sleep. A combination of techniques can help people with insomnia fall asleep faster, wake up less frequently and sleep more restfully. Research shows that these techniques work as effectively as sleep medication, without the side effects and risk of dependency.
Develop good habits that prepare you for sleep:
1. Set a regular schedule to go to bed at night and get up in the morning. Stick to the schedule even if you are awake a lot at night.
2. Develop regular rituals to move yourself toward sleep: discontinue caffeine four to six hours before bedtime and minimize daily use; avoid nicotine, especially near bedtime and on wakening; avoid the use of alcohol in the late evening; avoid heavy meals too close to bedtime; avoid vigorous exercise within three to four hours of bedtime. Do something relaxing before bed. Develop a comforting routine.
3. Use the bed only for sleep and sex. Do not read, watch television or talk on the phone in bed. This way, in your mind, bed means sleep and only sleep. Do not sleep anywhere but your bed.
4. Minimize light, noise, and excessive temperatures during the sleep period. Do not have the clock visible at night. Checking the clock creates tension.
5. Do not take daytime naps.
6. Restrict the amount of time spent in bed as close as possible to the actual sleep time. Go to bed only when you are sleepy, not just tired but sleepy. Too much time in bed results in sleep that is less efficient and less rejuvenating for the body.
If you have trouble falling asleep (or trouble going back to sleep):
1. Progressive muscle relaxation can reduce muscle tension and contribute to relaxation. Count your breaths, or simply think “in” and “out” with each breath.
2. If you donʼt fall asleep within 30 minutes, get out of bed and leave the room and return only when sleepy. Do no switch on the light or do anything active. Merely stand still, relaxing in the dark, with your mind as still as possible. Do not fight feelings of heaviness and drowsiness. Soon you will probably feel tired and will want to lie down. Return to bed, savoring your tiredness.
Control intrusive thoughts:
1. Often what gets in the way of sleep are intrusive thoughts–worrying or planning or anticipating or rehearsing. It is important to commit yourself to letting go of all such thoughts. The time for planning and solving problems is later. Give yourself positive coaching: “Everything is as it should be now. There is no need for me to lie awake thinking. Now is the time for delicious rest. I can simply go to sleep.”
2. Block intrusive thoughts. Often, negative thoughts about sleeplessness are “catastrophizing” and only increase tension and anxiety. “If I donʼt get enough sleep Iʼll be a wreck tomorrow.” “My insomnia is completely caused by a biochemical imbalance.” “I canʼt stand this any more.” Simply notice such thoughts, without judgment, and let them go.
Backhaus, J., Hohagen, F., Voderholzer, U., Riemann, D. (2001). Long-term effectiveness of a short-term cognitive-behavioral group treatment for primary insomnia. European Archives of Psychiatry & Clinical Neuroscience, Vol. 251, No. 1, pp. 35-41.
Bastien, C.H., Morin, C.M., Ouellet, M., Blais, F.C., Bouchard, S. (2004). Cognitive-behavioral therapy for insomnia: Comparison of individual therapy, group therapy, and telephone consultations. Journal of Consulting and Clinical Psychology, Vol. 72, No. 4, pp. 63-659.
Edinger, J.D., Wohlgemuth, W.K., Radtke, R.A., Marsh, G.R., Quillian, R.E. (2001). Cognitive behavioral therapy for treatment of chronic primary insomnia: A randomized controlled trial. Journal of the American Medical Association, Vol. 285, No. 14, pp. 1856-1864.
Morin, C.M. (2002). Contributions of cognitive-behavioral approaches to the clinical management of insomnia. Primary Care Companion, Journal of Clinical Psychiatry (suppl 1), pp. 21-26.
Morin, C.M., Blais, F., Savard, J. (2002). Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia? Behaviour Research & Therapy, Vol. 40, No. 7, pp. 741-752. Morin, C.M., Colecchi, C., Stone, J., Sood, R., Brink, D. (1999). Behavioral and pharmacological therapies for late-life insomnia: A randomized controlled trial. Journal of the American Medical Association, Vol. 281, No. 11, pp. 991-999.