Behavioral Therapy for Insomnia
Relaxation techniques, sleep restriction and other approaches offer relief.
The basics of sleep hygiene may not be enough, by themselves, to halt insomnia – especially in people 60 and older. “We can’t rely just on sleep hygiene when treating older adults behaviorally,” says Christina McCrae, PhD, assistant professor, health and clinical psychology, at the University of Florida. “We really need to consider other behavioral techniques.” Studies show that behavioral techniques are as effective as or better at treating insomnia than sleep medications among people of any age.
It’s helpful to have a sleep specialist work with you on most of these techniques.
Stimulus control: This technique mimics some methods from sleep hygiene and is aimed at associating the bed with sleep in your mind -- go to bed only when ready for sleep or sex; if you can’t fall asleep, get up and go into another room. Avoid naps, and get up at the same time every day, regardless of how little you’ve slept.
Sleep restriction: If you have no trouble falling asleep but can’t seem to stay asleep, you may be more likely to benefit from sleep restriction, Spielman says. The idea is to reduce the amount of time you spend asleep – at least at first – by going to bed 15 minutes later than usual. If your sleep doesn’t improve after a week, add another 15 minutes. Don’t go to bed earlier, even if you’re tired. (You never should reduce time in bed below five hours, however.) The short-term result is more sleep deprivation – but, over time, Spielman says, the goal is to help sleep correct itself, with wakefulness periods decreasing. As your sleep improves, start going to bed 15 minutes earlier. It’s helpful to have a sleep specialist work with you on this approach.
Relaxation techniques: Progressive muscle relaxation – alternately tensing and relaxing muscles – can help relieve anxiety. It takes about 10 minutes to perform. Another technique Spielman uses with his patients is to create a worry list each evening. Detail pressing worries in bullet points, along with potential solutions. Then set aside the list, mentally signaling that you’re done with worrying for that night.
Paradoxical intention: This is a psychological approach aimed at reducing anxiety about sleeping, and can help those who have trouble falling asleep. Basically, you engage in the behavior that causes anxiety – you tell yourself you’re going to stay awake instead of going to sleep. The idea is that if you stop trying so hard to sleep, you may be able to sleep more easily.
Cognitive restructuring: With this technique, you short-circuit negative, anxiety-causing thoughts about your insomnia. People can develop very negative or faulty conceptions of insomnia’s consequences, says Dr. Jamieson. For example, you may toss and turn at night, worrying that the next day will be ruined because you haven’t had any sleep. “Everything that goes wrong that day is misattributed to the fact that you didn’t get your quota of sleep last night,” he says. “We try to deprogram that.” As you worry less, sleep may come more quickly.
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