Fatigue & insomnia

Alternative treatments for insomnia

If you’ve tried tackling insomnia on your own — or even with a doctor — and still aren’t sleeping, there are many alternative behavioral treatments to look into.

As you explore, keep in mind that treating insomnia is deeply personal and in order to be successful, you have to find what works for you. Don’t be afraid to ask for help. Many behavioral approaches to insomnia (including cognitive behavioral therapy, sleep restriction therapy, light therapy and acupuncture) are best implemented into your daily routine under the guidance of a trained sleep clinician or therapist. For most people, these methods are neither time-consuming nor costly, and are so much more beneficial for your long-term health than any sleep medication could ever be.

Cognitive Behavioral Therapy (CBT)

Changing your attitude toward sleeping may be the best way to develop long-term, positive sleeping patterns. Many clinicians have long held the perception that behavioral therapy is cumbersome and for them, compared to writing a prescription, it is. However, recent studies show that it works. In a comprehensive review of 37 insomnia treatment studies on over 2000 people, behavioral approaches such as cognitive behavioral therapy (CBT) and relaxation training were more successful than medication, hands down. And their benefits were found to hold true for both primary insomnia and secondary insomnia. In fact, the American Academy of Sleep Medicine has recently updated its practice guidelines to use behavioral therapy as first-line treatment for insomnia.

CBT methods may combine a number of elements, including education, advice, psychotherapy, stimulus control and sleep restriction. One premise of cognitive therapy is that merely thinking about sleeplessness and all of the problems it causes the next day leads to ongoing insomnia. Through therapy, CBT can teach a person how to develop a more positive outlook on sleep, while simultaneously encouraging better “sleep hygiene,” or behaviors that are conducive to restful sleep, such as turning off the TV and staying out of bed unless you’re sleeping or having sex.

To learn more about CBT or to find a therapist trained in these methods, visit the website of the National Association of Cognitive Behavioral Therapists or the American Institute for Cognitive Therapy.

Sleep Restriction Therapy (SRT)

Maybe you don’t need eight hours of sleep every night and by waking frequently in the night, your body is trying to tell you that. A number of sleep restriction “schools” have arisen to help the sleepless determine their ideal sleep time. The overall goal of these methods is to decrease the amount of time the insomniac spends lying awake in bed, which sleep experts believe may perpetuate insomnia.

With sleep restriction therapy (SRT), the goal is to find your body’s threshold for sleep — whether it’s five hours or nine hours. In one form of SRT, the first step is the unthinkable: you don’t allow yourself sleep for at least 24 hours and your body is begging for a snooze. Once you get yourself to sleep, you then get up sooner than you’d like, day after day, until exhaustion sets in at night and you fall asleep easily and rest soundly. The idea is to gradually increase your sleeping time until you reach your personal sleep threshold, and eventually you feel well rested every morning.

In another variation of SRT, you might keep a sleep log for a couple of weeks and have your data evaluated by a sleep clinician who estimates your sleep efficiency, that is, the time you spent asleep divided by the time you spent in bed. Then you’re given a prescription to spend only a certain number of hours in bed, while continuing to monitor your sleep efficiency over the next few days. Your prescribed time in bed is then extended or decreased by quarter-hour intervals until you reach maximal sleep efficiency.

These methods may seem severe, but life without sleep can be even more troublesome. If SRT sounds interesting to you, consider referral to a sleep lab. A treatment course can be designed to help your particular needs. Most large cities and many smaller metropolitan areas now have sleep clinics. Ask your healthcare practitioner for a referral or check your Yellow Pages for more information.

Light therapy

Light has a dramatic effect on the circadian rhythm of most life forms, and human beings are no exception. Exposure to direct, intense light or sunlight before trying to go to sleep can make your body think it should be awake. Alternately, sunlight streaming through your bedroom window in the morning will signal your brain that it’s time to wake up. In fact, it’s believed that exposure to even a very small amount of light in the middle of the night will alter your circadian clock.

Light therapy, also known as phototherapy, works by exposing patients to specific wavelengths of light for a set amount of time. It has been used for seasonal affective disorder, depression, sleep disorders and even skin disorders. New research shows that our biological clocks are most responsive to a certain wavelength of light similar to the color of a blue sky. Using this blue light in the early evening can help people who have trouble falling asleep or staying asleep to sleep solidly throughout the night. This connection occurs because the receptors for the specific blue light in our eyes link directly to the suprachiasmatic nucleus, the part of your brain that regulates your circadian rhythm.

Progressive muscle relaxation

Practitioners have used progressive muscle relaxation for certain forms of pain, high blood pressure and insomnia. It is based on the theory that relaxing the body will in turn relax the mind. Starting from the outer extremities and progressively moving toward the face, you tense and relax muscle groups one at a time to reach a state of deep relaxation. Practice tensing and relaxing the muscles throughout your body until you can recognize the difference between a contracted and a relaxed muscle. When it’s time for sleep, you’ll be able to bring your muscles to rest while your overwrought mind drifts off.

Directed imagery

Feeling out of control of your daily life can make you lose control of your sleep. Many people lie down to sleep and find themselves thinking about stressful events that occurred during the day. Thinking of these problems while in bed gives you even less power over them than while you are dealing with them during the day.

Directed imagery is based on restoring your power and control. With this technique, you perform a specific mental task that can be solved easily prior to or at bedtime. The completion of the task helps to restore positive control and can also distract you enough to allow you to fall asleep. For people whose insomnia seems to be caused by an unusual amount of anxiety, directed imagery can be an emotionally satisfying treatment.

Emotional Freedom Technique (EFT) and acupuncture

Many times sleeplessness can stem from emotional turmoil, which blocks energy flow over time. Both EFT and acupuncture have been used to treat insomnia by acting on pressure points to unblock energy channels in your body and restore positive energy flow. While acupuncture uses thin needles to open energy lines, EFT can be done with your fingers. These techniques can reduce anxiety and help you sleep by opening your energy channels.

To learn more, read our article on emotional well-being and the Emotional Freedom Technique.

Meditation

Meditating is another way to rid your mind of the events that take place during your day and clear your head for sleep. With a warm, quiet space, you can practice meditation anywhere. By quieting the nervous system, the Transcendental Meditation program has shown positive results in treating insomnia. And those who meditate find that they get more quality sleep and feel more alert during the day. It is usually practiced for 15–20 minutes, two times per day in a quiet place while sitting comfortably. In meditation, the focus of your mind should be on your mantra and/or your breathing, though other thoughts may enter your head. As long as you acknowledge those thoughts and move on, however, you can achieve a meditative state.

Write it out

Keeping a journal of what is on your mind can help you get at the root of insomnia as well. As you do this, set a time for yourself every day and write down whatever comes into your mind. Don’t worry about complete sentences or logic. Known as stream-of-consciousness writing, this method can help you access emotional or psychological issues buried beneath the surface. It is also a way for you to process and resolve these issues, by literally taking them from your mind to the piece of paper. You may also want to look into the proprioceptive writing method. Alternatively, consider keeping a log of your dreams as a doorway to your inner self. All these meditative writing techniques can help clear the mental clutter your brain has to sift through and organize each night. What you learn from this process can be invaluable to health and happiness.

All of the above methods can prove fruitful in resolving your insomnia, no matter how entrenched it may seem. Be open to trying one or a combination of several that speak to you. The benefits of a behavioral modification approach are not limited to resolving sleeplessness, fatigue and stress, but extend to all levels of health and wellbeing.

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References & further reading on alternative insomnia treatments

 

Original Publication Date: 01/02/2007
Last Modified: 02/16/2010
Principal Author: Genevieve Morgan