What are non-pharmacological treatments for insomnia?

From the Guidelines

Cognitive Behavioral Therapy for Insomnia (CBT-I) is the most effective non-pharmacological treatment for insomnia, and it should be considered as the first-line treatment. This approach involves techniques like stimulus control, sleep restriction, and relaxation methods such as deep breathing, progressive muscle relaxation, or meditation 1. Other non-pharmacological treatments, including brief therapies for insomnia (BTIs), sleep restriction therapy, stimulus control, and relaxation therapy, may also be useful, but CBT-I has the most evidence to support its effectiveness 1.

Some key considerations for implementing CBT-I include:

• It is a multicomponent intervention that can be delivered in-person, in groups, or through internet-based programs 1
• The treatment typically ranges from 4-8 visits, and patients may face barriers to accessing CBT-I, including higher out-of-pocket costs and locating a skilled provider in their geographic region 1
• Clinicians should discuss different CBT-I delivery modalities with their patients and align the delivery modality based on availability, affordability, treatment format, duration, and the patient’s preferences and values 1

In addition to CBT-I, other non-pharmacological strategies that may be helpful for insomnia include:

• Maintaining a consistent sleep schedule and creating a comfortable sleep environment that is dark, quiet, and cool
• Avoiding caffeine, alcohol, and electronic devices before bedtime
• Engaging in regular physical exercise during the day, but avoiding vigorous activity close to bedtime
• Using light therapy to reset the circadian rhythm, particularly for those with delayed or advanced sleep phase disorders

It is essential to note that while sleep hygiene is not recommended as a single-component therapy due to the lack of evidence for its efficacy, certain common-sense principles of sleep hygiene may still be helpful in a comprehensive treatment approach 1. However, clinicians should prioritize CBT-I and other evidence-based treatments over sleep hygiene alone.

Overall, non-pharmacological treatments for insomnia, particularly CBT-I, offer a safe and effective approach to managing insomnia, with sustainable results and minimal undesirable effects 1.

From the Research

Non-Pharmacological Treatments for Insomnia

Non-pharmacological treatments for insomnia include a range of approaches that can be effective in managing the condition. Some of the key treatments are:

• Cognitive-behavioral therapy for insomnia (CBT-I) [ 2, 3 ], which is considered the standard of care for chronic insomnia and has been shown to be efficacious in improving sleep outcomes.
• Sleep restriction therapy [ 2, 4 ], which involves restricting the amount of time spent in bed to improve sleep quality.
• Stimulus control therapy [ 2, 4 ], which involves removing stimuli that can interfere with sleep, such as electronics and distractions.
• Relaxation training [ 2, 4 ], which can help reduce stress and anxiety that can contribute to insomnia.
• Sleep hygiene education [ 2, 4 ], which involves teaching patients about healthy sleep habits, such as maintaining a consistent sleep schedule and creating a sleep-conducive environment.
• Cognitive restructuring [ 3, 4 ], which involves identifying and challenging negative thoughts and beliefs that can contribute to insomnia.
• Exercise and physical activity [ 5 ], which can help improve sleep quality and reduce symptoms of insomnia.
• Complementary and alternative approaches, such as light therapy, aromatherapy, music therapy, and herbal medicine [ 5 ], which may be effective in managing insomnia, although more research is needed to fully understand their effects.

Key Components of Non-Pharmacological Treatments

The key components of non-pharmacological treatments for insomnia include:

• Identifying and addressing underlying causes of insomnia, such as stress, anxiety, and depression [ 2, 3 ].
• Establishing a consistent sleep schedule and creating a sleep-conducive environment [ 2, 4 ].
• Avoiding stimulants and electronics before bedtime [ 2, 4 ].
• Engaging in relaxation techniques, such as deep breathing and progressive muscle relaxation [ 2, 4 ].
• Keeping a sleep diary to track sleep patterns and identify areas for improvement [ 6 ].

Effectiveness of Non-Pharmacological Treatments

Non-pharmacological treatments for insomnia have been shown to be effective in improving sleep outcomes and reducing symptoms of insomnia [ 2, 3, 4, 5, 6 ]. These treatments can be used alone or in combination with pharmacological treatments, and can be tailored to meet the individual needs of each patient.