Sleep Disorders: Behavioral Treatments from WebMD

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Sleep Disorders:
Behavioral Treatments

Lifestyle/behavioral treatments for sleep disorders may include:

• Relaxation training
• Cognitive therapy
• Stimulus control (SC)
• Sleep restriction therapy (SRT)
• Sleep hygiene

Methods such as progressive muscle relaxation (PMR), deep breathing techniques, imagery, and self-hypnosis may help some people overcome a sleep disorder. PMR involves helping the individual to sequentially tense and relax the bodys major muscle groups while concentrating on and contrasting sensations of tension and relaxation. Daily practice of relaxation techniques between therapy sessions is essential and tends to enhance the effectiveness of the treatment.

Cognitive therapy helps people with insomnia identify and correct inappropriate thoughts and beliefs that may contribute to insomnia. Cognitive therapy can give people the proper information about sleep norms, age-related sleep changes, reasonable sleep goals, and the influence of naps and exercise.

SC derives from the belief that insomnia may be related to the bedrooms having become associated with other things (stressful situations, for example) besides sleep and sex. Therefore, the bedroom should be reserved for sleep, sex and dressing only.

SRT is based on the belief that excess time in bed makes sleep problems worse. SRT consists of limiting a person's time in bed to only that time where they are sleeping. Then, over time, slowing lengthening this period of time to the individuals optimal sleep time.

This refers to practices, habits and environmental factors that are important for getting sound sleep. The four general areas important to sleep hygiene are the circadian rhythm (24-hour cycle), aging, psychological stressors that cause mini-awakenings (in which the brain wakes up for just a few seconds), and stimulant use.

• Circadian rhythms influence when, how much, and how well people sleep. These rhythms may be altered by the timing of various factors, including naps, bedtime, exercise, and exposure to light.
• Aging also plays a role in sleep. Sleep patterns change after people reach the age of 40. There are many more nocturnal awakenings as people age. The awakenings affect sleep quality and can interact with any other condition that may cause arousals or awakenings. The more awakenings people experience at night, the more likely they will awaken with a feeling of not being rested.
• Psychological stressors such as exams, deadlines, or job problems may interfere with sleep. It is beneficial for people to develop some kind of pre-sleep ritual to break the connection between stress and bedtime. Some people find it helpful to make a list of all the stressors of the day, along with a plan to deal with them. In addition, periods of relaxation (meditating or taking a hot bath) can help a person relax and get to sleep.
• Stimulants can stay in the body as long as 14 hours and can increase the number of times you awaken at night, decreasing your total amount of sleep time. Avoid caffeine, nicotine and alcohol. The effects of nicotine, when consumed in high doses, are similar to those of caffeine. Alcohol may initially sedate you, making it easier to fall asleep. The downside to alcohol is that as it is metabolized and cleared from your system during sleep, it causes arousals that can last as long as two to three hours after it has been eliminated.

Reviewed by The Sleep Medicine Center at The Cleveland Clinic.

Edited by Michael Breus, MD Sept 2007.

SOURCE: American Academy of Sleep Medicine.