How to Get to Sleep without Meds

Chronic insomnia is common – it’s seen in 10% to 30% of US people today, according to a review in the American Family Physician. Non-pharmacological techniques, which are quite reliable and provide sustained relief, are discussed in the journal article. Here’s a summary of the main points for self-help.

Sleep Hygiene Avoid the following late in the day: caffeine, nicotine, exercise, a heavy meal, too much fluid intake. Avoid naps. Regular bedtime hours. No TV or reading in bed. Comfortable bedroom temperature, as dark as possible. Earplugs if necessary.

Relaxation Techniques Reduce level of arousal by:

visualizing a peaceful environment, comfortable sensations (warmth, heavy limbs, cool forehead), pleasant or neutral images;

meditation, with or without a repetitive word, sound, prayer, or phrase;

paced respiration – hold a deep breath for 5 seconds, repeat several times, focus on sound of breathing;

progressive muscle relaxation, tensing and relaxing from the feet upwards.

And, if necessary, move on to getting help from experts:

Sleep restriction Limit the time spent in bed; if sleep efficiency (total sleep time as %age of time spent in bed) exceeds 90%, time in bed can be increased by 15-20 minutes. (‘Paradoxical intention’ seeks to remove the fear of sleep by advising the subject to remain awake.)

Cognitive Behavior Therapy (CBT) 4-8 weekly 1-hour sessions that help identify dysfunctional beliefs about sleep, then challenge their validity, and finally replace them with substitutes allowing better adaptation. The ‘self-help’ measures above are incorporated and/or reinforced.

Other Measures Visual or auditory biofeedback training to help the patient control disturbing physiological reactions. Hypnosis can be effective for some people.

The authors of the review, who come from Dallas, recommend CBT as initial therapy – evidence of effectiveness is available, and it’s more likely to produce sustainable results. If immediate relief is necessary, medications are helpful.