Alternative Therapies for Insomnia
" More than 1.6 million U.S. adults are estimated to use complementary and alternative therapies to treat insomnia or trouble sleeping, according to the results of a national survey published in the September 18 issue of Archives of Internal Medicine."
Insomnia is the most common sleep disorder, and is often associated with significant medical, psychological, and social disturbances. Conventional medical treatment for insomnia includes psychological and pharmacological approaches; however, long-term use of frequently prescribed medications can lead to habituation and problematic withdrawal symptoms. Therefore, herbal and other natural sleep aids are gaining popularity, as herbs commonly used for their sedative-hypnotic effects do not have the drawbacks of conventional drugs. Whether alternative therapies possess activity similar to conventional therapies needs further evaluation. (Treatment of insomnia: an alternative approach. PubMed)
Both the National Institutes and the American Academy of Sleep Medicine have stated that biofeedback used in conjunction with relaxation training can help with sleep problems. This therapy is rated as probably efficacious (level 3 on a scale of 1 - 5 with 5 being the best).
Biofeedback is a technique in which people are trained to improve their health by learning to control certain internal bodily processes that normally occur involuntarily, such as heart rate, blood pressure, muscle tension, skin temperature, sweat, and blood flow through the hands and feet. These activities can be measured with electrodes and displayed on a monitor that both the participant and his or her practitioner can see.
Scientific evidence of Biofeedback effectiveness
- Treating psychophysiologic insomnia with biofeedback. PubMed
- Biofeedback and progressive relaxation treatment of sleep-onset insomnia: a controlled, all-night investigation. PubMed
- The treatment of psychophysiologic insomnia with biofeedback: a replication study. PubMed
- The use of EEG theta biofeedback in the treatment of a patient with sleep-onset insomnia. PubMed
Acupuncture is one of the oldest, most commonly used medical procedures in the world. Originating in China more than 2,000 years ago, acupuncture began to become better known in the United States in 1971, when New York Times reporter James Reston wrote about how doctors in China used needles to ease his pain after surgery. The acupuncture technique that has been most studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation at specific acupuncture points in order to influence the functioning of the body.
The FDA approved acupuncture needles for use by licensed practitioners in 1996. The FDA requires that sterile, nontoxic needles be used and that they be labeled for single use by qualified practitioners only.
Acupuncture is often used in Traditional Chinese Medicine for the treatment of insomnia. It stimulates the production of certain chemicals in the brain, including serotonin, which appear to help you sleep.
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Progressive muscle relaxation (PMR)
Progressive muscle relaxation is another effective technique for inducing sleep. It has been effectively used to control stress and anxiety, relieve insomnia, and reduce symptoms of certain types of chronic pain. It may be helpful for older individuals and some patients with secondary insomnia caused by a medical or psychiatric condition. The technique of progressive muscle relaxation was described by Edmund Jacobson in the 1930s and is based upon his premise that mental calmness is a natural result of physical relaxation.
Progressive muscle relaxation is a deep relaxation technique, based upon the simple practice of tensing, or tightening, one muscle group at a time followed by a relaxation phase with release of the tension. People who suffer from insomnia often report that practicing progressive muscle relaxation at night helps them fall asleep.
Most practitioners recommend tensing and relaxing the muscle groups one at a time in a specific order, generally beginning with the lower extremities and ending with the face, abdomen, and chest.
- While inhaling, contract one muscle group (for example your upper thighs) for five to ten seconds, then exhale and suddenly release the tension in that muscle group.
- Give yourself 10-20 seconds to relax, then move on to the next muscle group (for example your buttocks)
- While releasing the tension, try to focus on the changes you feel when the muscle group is relaxed. Imagine that stressful feelings are flowing out of your body as you relax each muscle group.
- Gradually work your way up the body contracting and relaxing muscle groups.
Resources:
- Biofeedback and progressive relaxation treatment of sleep-onset insomnia: a controlled, all-night investigation. PubMed
- Treating insomnia with a self-administered muscle relaxation training program: a follow-up. PubMed
- Progressive relaxation, EMG biofeedback and biofeedback placebo in the treatment of sleep-onset insomnia. PubMed
- Behavioral and hypnotic treatments for insomnia subtypes. PubMed
- Application of the relaxation technique in general hospital psychiatry. PubMed
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy (CBT), is relatively simple and short-term treatment. CBT has long been used to treat a range of problems, including depression, panic attacks, eating disorders and substance abuse. Now, it has also proved effective against insomnia. So effective, in fact, that for most people it works better than sleeping pills and with no side effects. Cognitive-Behavioral Therapy typically consists of some form of therapy to eliminate the misconceptions and faulty beliefs about sleep that many insomnia sufferers have.
CBT methods may combine a number of elements, including education, advice, psychotherapy, stimulus control and sleep restriction. One premise of cognitive therapy is that merely thinking about sleeplessness and all of the problems it causes the next day leads to ongoing insomnia. Through therapy, CBT can teach a person how to develop a more positive outlook on sleep, while simultaneously encouraging better “sleep hygiene,” or behaviors that are conducive to restful sleep, such as turning off the TV and staying out of bed unless you’re sleeping or having sex.
It is a recommended treatment option for a number of mental disorders, including affective (mood) disorders, personality disorders, social phobia, obsessive-compulsive disorder (OCD), eating disorders, substance abuse, anxiety or panic disorder, agoraphobia, post-traumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder (ADHD). It is also frequently used as a tool to deal with chronic pain for patients with illnesses such as rheumatoid arthritis, back problems, and cancer. Patients with sleep disorders may also find cognitive-behavioral therapy a useful treatment for insomnia.
Resources:
- Does cognitive-behavioral insomnia therapy alter dysfunctional beliefs about sleep? PubMed
- Cognitive behavioral therapy for treatment of chronic primary insomnia: a randomized controlled trial. PubMed
- Concept for a behavior therapy treatment program in primary insomnia
- Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. PubMed
- Cognitive-behavioral therapy for insomnia: comparison of individual therapy, group therapy, and telephone consultations. PubMed
- Cognitive-behavior therapy for late-life insomnia. PubMed
- Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. PubMed
- Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. PubMed
Sleep Restriction Therapy (SRT)
This treatment, first introduced by Arthur Spielman and colleagues in 1987, grew out of the observation that many people with insomnia stay in bed hoping this will produce more sleep time.
With sleep restriction therapy (SRT), the goal is to find your body’s threshold for sleep — whether it’s five hours or nine hours. In one form of SRT, the first step is the unthinkable: you don’t allow yourself sleep for at least 24 hours and your body is begging for a snooze. Once you get yourself to sleep, you then get up sooner than you’d like, day after day, until exhaustion sets in at night and you fall asleep easily and rest soundly. The idea is to gradually increase your sleeping time until you reach your personal sleep threshold, and eventually you feel well rested every morning.
The treatment begins by having the individual maintain a sleep log to record each night of sleep. After they have maintained a sleep record for about two weeks, the average total sleep time (ATST) is calculated from the information recorded. Using this information, the individual is instructed to stay in bed no longer than ATST + 30 minutes. The time in bed (TIB) is increased by 15-20 minute increments following weeks during which the individual insomnia sufferer sleeps relatively well but continues to report daytime sleepiness. Conversely, TIB is usually reduced by similar increments following weeks during which the individual continues to have difficulty sleeping. Since TIB adjustments are usually necessary, this therapy typically requires an initial office visit to introduce treatment instructions and follow-up visits to alter TIB instructions
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Light therapy also known as phototherapy, is a treatment used for people who suffer from circadian rhythm sleep disorders. Your body has an internal clock that tells it when it is time to be asleep and when it is time to be awake. These disorders include the following: Delayed sleep phase disorder, Advanced sleep phase disorder, Free-running or Non-24-hour sleep-wake rhythm, Jet lag, Shift Work, Seasonal affective disorder (SAD).
Light therapy works by exposing patients to specific wavelengths of light for a set amount of time. New research shows that our biological clocks are most responsive to a certain wavelength of light similar to the color of a blue sky. Using this blue light in the early evening can help people who have trouble falling asleep or staying asleep to sleep solidly throughout the night. This connection occurs because the receptors for the specific blue light in our eyes link directly to the suprachiasmatic nucleus, the part of your brain that regulates your circadian rhythm.
Artificial light may be used to affect the body clock in the same way that sunlight does. New advances continue to be made in this field.
Resources:
- Sleep quality during alcohol withdrawal with bright light therapy. PubMed
The purpose of stimulus control therapy is to reestablish the bed as the place where sleep happens, rather than the site of sleeplessness. Through this therapy, you are encouraged to go to bed only when it's time for sleep. If you are not asleep within 15 minutes, leave the bedroom and don't return until you are sleepy. You are also encouraged to have a consistent wake time every day, regardless of how much sleep you got, and to avoid naps in any location but the bed.
Meta-analytic studies indicate that stimulus control treatment can reduce the average self-reported time for sleep onset from 64 minutes before treatment to 33 minutes after treatment. Also, the average total time awake after sleep onset is reduced from 84 minutes before treatment to 44 minutes after treatment.
In practice, stimulus control requires that insomnia sufferers:
- go to bed only when sleepy
- establish a standard wake-up time
- get out of bed whenever awake for more than 15-20 minutes
- avoid reading, watching TV, eating, worrying and other sleep-incompatible behaviors in the bed and bedroom
- refrain from daytime napping
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Yoga has a stimulatory effect on the nervous system, and in particular the brain. The practice of certain yoga postures will increase the blood circulation to the sleep center in the brain, which has the effect of normalizing the sleep cycle.
If you suffer from insomnia, whether it's only occasionally or if it's chronic, yoga might be one way of overcoming it without resorting to sleeping pills. If you have trouble falling asleep when you first go to bed, try about 30 minutes of slow yoga stretches and meditation about thirty minutes before bedtime.
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