How to Fix Broken Sleep

... and why what many doctors advise may not be enough.

Posted Jun 01, 2015

Source: iordani/Shutterstock

Countless people suffer from insomnia, staying awake when they want to be asleep. Insomnia can affect you at the beginning, middle, or end of the night. Whenever it occurs, it is extremely frustrating and people will try almost anything to get relief. What are the best treatments for chronic insomnia? According to the American Academy of Sleep Medicine, a few alternatives have been shown to be effective, including:

  • Stimulus Control Therapy. This treatment is designed to form a strong link between bed and sleep. It includes things like getting out of bed if not falling asleep and using the bed only for sleeping (and sex). The goal is for the mind to learn that bed=sleep so we fall asleep quickly once we get under the covers.
  • Relaxation Training. After repeated anxious nights of terrible sleep, many people start to associate the bed with tension and frustration. This training teaches effective relaxation methods, which can help you fall asleep and reduce the bedtime anxiety that often goes along with difficulty sleeping.
  • Sleep Restriction. In this highly effective though somewhat counterintuitive approach, a person’s time in bed is matched to the time the person actually spends sleeping (based on his or her sleep records). It generally leads to falling asleep quickly and sleeping soundly, and also fits well with stimulus control therapy in that it reinforces an association between bed and sleep.

These individual components are often combined into highly effective treatment packages known as cognitive behavioral therapy for insomnia or CBT-I. Many studies have shown that CBT-I can help most people with insomnia to sleep much better. (Some medications can actually do about as well as CBT-I in the short-term, but long-term outcomes are generally better with CBT-I.)

A study in The Behavior Therapist asked treatment providers a crucial question: What do you recommend for patients with insomnia, in light of the treatments that are known to be effective? According to the survey results, 88 percent of health practitioners (including physicians, psychologists, nurses, and others) recommended improved sleep hygiene as a stand-alone treatment for insomnia. (Sleep hygiene includes making sure your bedroom is cool, dark, and quiet; limiting caffeine intake; and avoiding excessive fluid intake in the evening.) Only about 30 percent of practitioners recommended stimulus control, and around 25 percent recommended sleep restriction. These numbers were in line with what practitioners believed about the effectiveness of these treatments.

Painting by Edward Coley Burne-Jones, photo via Wikimedia Commons
Source: Painting by Edward Coley Burne-Jones, photo via Wikimedia Commons

The study’s authors lamented that treatment providers most often recommended sleep hygiene—even though there is little evidence for its effectiveness as a standalone treatment. (It is often included as a part of CBT-I). In light of existing studies and practice guidelines, it's critical to make both the public and health providers aware that sleep hygiene alone is not supported by solid research evidence. More powerful, better-tested treatments are available.

Promoting the best information is crucial: After all, good sleep helps nearly everything else in our lives.

A list of tips for good sleep can be found here.