Non-Pharmaceutical Management of Insomnia

The best insomnia treatments do not involve drugs.  We are not anti-drug at Sleepdex®.  Medicines are a technology humans have developed to help us, and appropriate use of medicines can assist millions and should not be looked down upon.  But the considered opinion of thoughtful public health officials is that if you can avoid drugs in addressing your sleeping problems, so much the better.

The risk of dependency (both physical and psychological, however mild), the cost, the changes in sleep architecture which all sleeping pills produce – these are enough to prefer non-pharmaceutical intervention if it works.

Drug interactions are another reason to avoid sleeping pills, if you already take another pill regularly.  Although drug companies, the FDA, and the larger medical community attempt to anticipate negative interactions among different drug combinations, they cannot always do so.

Many people don’t like pharmaceuticals because they consider using drugs to get to sleep to be a crutch.  The crutch analogy is somewhat misplaced.  If drugs truly were like a crutch for a broken leg that would be better.  The broken bone clutch is an explicitly temporary device to aid the patient until the bone heals enough to allow unaided walking.  If sleeping pills were used in that way – to help people sleep during a transient period of insomnia, that would be ideal. Unfortunately, many patients can not or will not end use of the drugs.

Some methods:

Sleep hygiene

Everyone should practice good sleep hygiene anyway, and when sleep problems first become noticeable, the things to check include temperature and darkness of the bedroom, comfort of the beddings, clothing, and regular schedule for bedtime and rising time.

Cognitive behavioral therapy

Although time consuming and expensive, cognitive behavioral therapy is widely considered to be the most effective treatment for mild to moderate insomnia for the long run.  In these days of trying to get the cost of healthcare down, CBT is often forgotten when drugs can work so much faster and cheaper.

Substitution of other drugs that cause insomnia

This refers to medicine for other things, not sleep disorders.

Many drugs cause insomnia as a side effect, and if the insomniac notices sleep disturbances upon starting or modifying a medicine, it is worth mentioning this to the prescribing doctor.  It may be possible to get another medicine that does not interfere with sleep.

Light therapy

Light therapy is employed mainly for circadian disorders, which are a common cause of insomnia.  Light therapy is totally drug-free. Light is important in so much of our circadian cycles.

Sleep restriction therapy

Intentionally limiting time in bed so that the insomniac has fewer chances to lie awake is proven to help battle insomnia, and involves no medication.  This is related to CBT, and can be done under the supervision of a therapist, but anyone with enough self-discipline should be able to manage it on their own.

Buddha sleeping Another technique is called paradoxical intention.  The person takes care to establish good sleep hygiene but tries to lie in bed and NOT fall asleep.

Formal relaxation therapy – there are many regimens – helps some people get into a state conducive to sleep before they go to bed.  Lullabies are arguably a form of relaxation therapy for small children and music can be useful for adults, too.

CPAP machine

CPAP machines are used to help people with sleep-disordered breathing.  They are not specifically FDA-approved for insomnia, but because breathing problems induce sleep maintenance insomnia, CPAPs can help.  They are quite expensive, and although covered by many insurance policies, the coverage is generally only if you have been diagnosed with apnea.

Vacation

Taking a break from life’s routine usually helps people sleep.  On vacation, especially away from home in a relaxing setting, many people can sleep better, and more.  Often the vacationer finds it easy to sleep in daytime naps, so even if the nighttime sleep is not improved, total sleep time increases.

Although vacations can help people repay their sleep debt and get back on a good sleep schedule, overly long vacations (or retirement and unemployment) are not always a good idea because the lack of structure leads to too much sleep.

Exercise

We have a separate page on exercise and sleep. It is overly simplistic to say exercise helps you sleep, although generally people in better health have better sleep.

Eating and Drinking

Eating a big meal can help many get to sleep.  Many people employ alcohol partly to help with insomnia, although this method can backfire on you and is probably not viable in the long run.

 

Quick fixes for insomnia.

 

 

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