When it comes to the best treatment option for insomnia, there is a ton of conflicting information out there.
I see plenty of bad advice handed out to people suffering from insomnia and I see many so-called insomnia cures that have little (or no) evidence on their safety or effectiveness get recommended on a regular basis.
Let's change all that, starting today.
The American Academy of Sleep Medicine conducts comprehensive reviews of scientific literature on a periodic basis to help determine which insomnia treatments actually work.
Want to know how to cure insomnia? Continue reading! Listed below are the insomnia treatments that have been comprehensively reviewed and graded by experts appointed by the American Academy of Sleep Medicine.Legend
Standard recommendation; a generally accepted strategy with a high level of clinical certainty.
Guideline; a strategy with a moderate degree of clinical certainty.
Uncertain clinical use; inconclusive or conflicting evidence or expert opinion.
Cognitive behavioral therapy (CBT)
CBT combines cognitive and behavioral techniques to improve sleep. CBT addresses incorrect thoughts, beliefs, and behaviors towards sleep. These are often the root cause of many cases of insomnia .
Cognitive behavioral therapy for insomnia usually includes a combination of sleep education, stimulus control therapy, sleep restriction, relaxation training, and sleep hygiene education.
Relaxation techniques help reduce the mental arousal that can make sleep difficult. This mental arousal is sometimes described as a racing mind.
Relaxation training includes:
- Guided imagery
- Abdominal breathing
- Progressive muscle relaxation
Progressive muscle relaxation involves tensing and relaxing muscles throughout the body in a methodical fashion. There are many ways to do this. Here's one method:
- Lie in bed with the lights off
- While breathing in, tense the muscles in your toes for about five seconds
- Quickly release the tension and breathe out
- Relax for about 30 seconds. Feel the looseness in your relaxed muscles and notice how different they feel compared to when they were tensed
- Repeat one more time or move up the body to another muscle group (such as your calves) and repeat the process
- Continue until you reach the top of your body
Stimulus control therapy
This technique helps to associate the bed with sleep (not wakefulness) and converts negative associations into positive ones.
Stimulus control involves:
- Avoiding daytime naps
- Only going to bed when sleepy
- Keeping a regular sleep/wake schedule
- Getting out of bed if you can't fall asleep
- Using the bed for sleep and sexual activity only
This uses various components of CBT, but not all of them. For example, multicomponent therapy may include stimulus control, relaxation training, and sleep hygiene education — but not sleep restriction.
Although commonly referred to as sleep restriction, I prefer to use the term restricting time allotted for sleep in order to avoid the common misperception that sleep restriction reduces sleep duration. It doesn't!
This technique involves reducing the amount of time spent in bed to more closely match the amount of sleep you're getting. It is designed to increase sleep pressure, increase sleep duration, and help you associate the bed with sleep — not wakefulness.
To try this technique, you'll need to keep a sleep diary for at least a week. Every day, write down the time you went to bed the previous night, the time you got out of bed in the morning and how many hours of sleep you got.
The aim here is to make sure you do not spend more than an hour over your nightly sleep duration in bed .
Here's an example:
|Out of bed time:||6am||7.30am|
|Hours of sleep:||5 hours||5 hours|
|Total time in bed:||7 hours||9 hours|
In the example above, we can see that - on average - this individual is allotting eight hours for sleep each night ( (7+9) / 2 ). Yet, they are only averaging about five hours for sleep each night ( (5+5) / 2 ).Adding one hour to their average nightly sleep duration would mean allotting about six hours for sleep each night. This would be a more appropriate amount of time to allot for sleep.
This individual should now write down when they want to get out of bed each morning, deduct six hours from that time, and they have their new regular bedtime.
This amount of time allotted for sleep can be increased by half an hour each week as long as sleep efficiency remains above 85%. Sleep efficiency is measured by dividing sleep duration by time allotted for sleep, and multiplying by 100.
For example, if I spend seven hours in bed and get six hours of sleep, my sleep efficiency is 85.7%.
The insomnia remedy that many haven't heard of, paradoxical intention therapy involves confronting the fear of insomnia by trying to remain awake, but relaxed.
This addresses the 'performance anxiety' suffered by many insomniacs who struggle to fall asleep.
Biofeedback uses visual or audio feedback to help reduce arousal.
Sleep hygiene as a single therapy
It's important to note that sleep hygiene only comes without a recommendation when used as a single treatment strategy .
Sleep hygiene is a form of behavioral intervention that teaches individuals about lifestyle practices that impact sleep. It should be combined with other techniques such as sleep restriction, cognitive therapy, and stimulus control.
Sleep hygiene techniques include:
- Eating a healthy diet
- Getting regular exercise
- Keeping a regular sleep schedule
- Exposure to natural light in the day
- Avoiding caffeine and other stimulants
- Keeping the bedroom cool, dark, and quiet
- Avoiding exposure to artificial light at night
Imagery training as a single therapy
As with sleep hygiene, this technique only comes without a recommendation when used as a single treatment strategy.
Imagery training involves visualizing pleasant or neutral images with the aim of blocking out unwanted thoughts before sleep. The theory behind this is it can help promote relaxation and calm a racing mind before bed.
Cognitive therapy as a single therapy
Cognitive therapy is not the same as cognitive behavioral therapy. Cognitive therapy only aims to address incorrect thoughts, beliefs, and attitudes towards sleep. Unlike cognitive behavioral therapy, it does not specifically target the behaviors that influence sleep.
Cognitive therapy, when used within cognitive behavioral therapy, is effective and comes with a recommendation . Cognitive therapy as a single therapy does not.
The following are consensus-based recommendations and reflect the shared judgement of an expert insomnia panel assembled by the American Academy of Sleep Medicine:
- Short-term hypnotics should be supplemented with behavioral and cognitive therapies
- Those taking sleeping pills long-term should receive an adequate trial of cognitive behavioral therapy
- Over-the-counter antihistamines/analgesics and herbal/nutritional substances such as valerian and melatonin are not recommended for chronic insomnia due to lack of data on their safety and effectiveness
If you are struggling with sleep, speak to your doctor. Don't blindly follow the advice of others without doing your due diligence first!
Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults. Journal of Clinical Sleep Medicine, 4(5), 487–504.
Morgenthaler T., Kramer M., Alessi C., Friedman L., Boehlecke B., Brown T., Coleman J., Kapur V., Lee-Chiong T., Owens J., Pancer J., Swick T. (2006). Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report. Sleep, 29(11), 1415-9.
Last updated: November 30, 2016