Recent studies have clearly shown that drug-free treatments for insomnia tend to produce better results than sleeping pills. Also, according to the latest recommendations, non-drug treatments for insomnia are the primary treatments.
Behavioral methods in the treatment of insomnia
The behavioral method is based on psychological theories and methods of action in the treatment of insomnia. Its purpose is to eliminate learned bad behavioral habits and learn a new technique while considering the patient’s environment. Methods include conditioning, desensitization, and exposure. Relaxation is also one way what is used as an aid.
The goal of behavioral insomnia treatment is individual and cohesive sleep that supports sleep and sleep patterns. The method attempts to correct harmful things that result from insomnia. Often these problems have started before the onset of insomnia, but as the insomnia continues these things have become a problem.
Behavioral methods use methods to control sleep stimuli and limit time in bed. The intention is that you go to bed only while sleepy and the bed is not used for anything other than sleeping. The idea is to fall asleep in a short time. If you don’t fall asleep in about 15 minutes, you’ll get out of bed. The purpose of this is to get away from the pressure to fall asleep.
Long-term studies have shown that behavioral methods are more effective than drug treatment, because in therapy, the patient changes his habits, behaviors, and beliefs. Although the results of the therapy have to be waited for a few weeks, the results remain the same even when the therapy ends. But if medical insomnia treatment is stopped abruptly, the insomnia strikes again.
Behavioral therapy is not very common because doctors have no knowledge of psychological treatment methods. In addition, individual therapy may be too expensive, but group therapy has been suggested as an alternative. Self-care guides are, for the most part, the only option for raising awareness among patients.
Cognitive methods in the treatment of insomnia
Cognitive methods are the processing of information, ie they concern an individual’s world of thought, beliefs and imaginations. Theoretical models and practical means are introduced into the method.
The cognitive method aims to reduce hyperactivity associated with insomnia and bring peace of mind. The method aims to get rid of harmful thoughts and address their causes. The purpose is to reprocess harmful thoughts and evaluate the thoughts. For often they are related to beliefs, feelings, and presuppositions. Time must be set aside for the cognitive method for learning something new and practicing. Concerns and thoughts about that you don’t get enough sleep cause activation of the sympathetic nervous system and thus increase anxiety. Also, autonomic activation, a state of arousal of the body, and anxiety lead to internal (muscle tension) and external (barking of a neighbor’s dog) distractions from falling asleep.
What is sleep hygiene?
Sleep hygiene is also called sleep maintenance. It aims to eliminate malfunctions and problem factors. In sleep maintenance, attention is paid to the daily circadian rhythm. It includes maintaining a circadian rhythm, regularity, and removing stimuli that prevent sleep. In addition, sleep maintenance pays attention to good lifestyles, sleep routines and the environment. They are meant to promote good sleep.
It is recommended that if you do not fall asleep in 15-20 minutes, you should get out of bed and go to another room to do something peaceful. Only when you feel sleepy should you go back to bed. You should always get up at the same time in the morning, even on weekends to maintain a regular rhythm of life. Wake-up times should be adhered to regardless of the time you have gone to bed the night before. Calming down should be started an hour before bedtime by stopping the day’s chores and starting sleep rituals such as bathing and dimming the lights.
The bed and bedroom are only for sleeping and sex. Other activities in the bedroom such as taking care of things, chatting or studying in bed and eating will interfere with your sleep. Artificial light, cell phones, and other electronic devices make people avoid or suppress circadian cues about going to bed. Evening-weighted use of electronic devices that shine a bluish light delays the circadian rhythm and onset of sleep, suppresses melatonin, and increases morning drowsiness.
The effect of bed and bedding on sleep
Choosing a pillow is important for sleeping. A neck-supportive, dust-free, adaptable and breathable pillow is a good and important solution for many. When choosing a good pillow, you should consider your own size, sleeping position and comfort. The purpose of the pillow is to support the cervical spine so that the neck and shoulder line are in the correct position. Sleeping on your stomach is not recommended because the spine is then in the wrong position. Good sleeping positions are on your side or on your back positions.
You should invest in getting a good mattress and bed. The main function of the mattress is to support the back, as a bad mattress causes back pain and with it poor quality sleep. So a good mattress is appropriate, not too soft or too hard. Breathability, firmness and comfort should also be taken into account when choosing a mattress topper.
High quality and natural fiber bedding is the best as they breathe. It is recommended that the blanket be pleasant and airy. A heavy blanket can give you a sense of security and also peace of mind through a pro-prioseptic sensory nervous system.
Effect of sleeping temperature on sleep
The temperature in the sleeping room should be between 18-21 °C (64-70 °F). It would be advisable to ventilate the room before going to bed. Too low a temperature can cause intermittent sleep as the body produces and maintains heat. Freezing interferes with sleep, making sleep intermittent too.
The effect of light on sleep
The lighting in the bedroom should not be bright, as the light affects falling asleep. A dark room would be ideal for sleeping. During the light season, it is recommended to put on blackout curtains or wear a mask that covers the eyes.
The bright light treatment method has given good results in the treatment of insomnia. Major studies have found that sleep interruption is reduced more with bright light therapy than with dim lighting. Bright light has been found to improve sleep quality, help with difficulty falling asleep, and reduce fatigue. One study found that these effects lasted for up to three weeks. One randomized study compared light treatments lasting 20 and 45 minutes and found a better result with 45 minutes of treatment. In this case, the amount and quality of sleep were significantly improved with more than 20 minutes of bright light therapy.
The effect of napping on nighttime sleep
Daytime sleep should be taken only when necessary and should be concentrated in the afternoon. The recommendation is 10-20 minutes of sleep, as it should not affect night sleep. In some sources, it is recommended to avoid naps altogether. Napping has been shown to interfere with homeostatic sleep pressure, which is why sleep hygiene recommendations recommend avoiding daytime sleeps that last longer than 30 minutes. However, research findings on the subject are contradictory, as in most research findings, daytime sleep has had no effect on nighttime sleep. A few studies have found that daytime sleep causes fragmentation of sleep and, as a result, sleep efficiency is reduced.
The results clearly show that short naps lasting less than 30 minutes are good for cognitive functioning, alertness, and mood. Only a few studies have examined daytime sleep in the evening because they can relieve sleep pressure and thus make night sleep more difficult.
The effect of noise on sleep
Normal nocturnal noises in the human environment, such as traffic and music, can affect sleep even if they are not consciously noticed. The quality of sound, such as its continuity, type, and frequency, as well as personal differences, affect the response to sounds. In general, nocturnal sounds increase awakening times and the number of N1 and N2 dreams increases. In addition, slow-wave sleep and REM sleep are attenuated.
The sleeping environment should be quiet and peaceful, with a noise level below 25 dB. Sound-sensitive people find it difficult to fall asleep if there are even small sounds in the background, such as the ticking sound of an alarm clock. The use of earplugs is a good way because they make it easier to fall asleep. It is therefore important to work to eliminate annoying sounds that affect sleep.
The effect of exercise on sleep
Exercise is very important for sleep. It affects physical and mental well-being. It plays a big role in falling asleep, sleep quality and the next day’s alertness level. Exercise has a good effect on deep sleep by improving it. Tai Chi or walking in the woods will improve your quality of sleep. Yoga has been found to be associated with nocturnal awakenings and subsequent falling asleep occurs more rapidly. The positive effects of yoga can be due to either physical activity or leveling of body and mind.
The mechanisms of the sleep-enhancing effects of regular exercise are largely unknown. Still, it is suspected that sleep quality is improved by the effect of exercise on body temperature, alertness, and / or adenosine levels. Studies show that exercise significantly increases the amount of total sleep, N2 sleep, slow-wave sleep, and REM sleep delay. In addition, it slightly reduces the sleep delay. Studies have compared aerobic and endurance forms of exercise in accordance with exercise recommendations, but no differences have been observed in their effect on sleep.
The timing of exercise matters in getting sleep. Exercise that takes place close to bedtime can increase physiological alertness and interfere with sleep. The body can go overboard after a hard workout. Relaxed walking wouldn’t affect negatively.
According to collection studies, exercising 4-8 hours before going to bed is most effective, as it reduces the time to fall asleep the most. Some studies have found that exercise shortly before bedtime may improve sleep quality. This was justified by the increase in body temperature, as well as the anxiolytic and antidepressant effects of exercise.
Stress is part of sleep hygiene
Although stress has not traditionally been part of sleep hygiene, new recommendations suggest that reducing worries or doing relaxing things before going to bed is part of sleep hygiene. Stress increases cognitive and physiological alertness, both of which are detrimental to sleep intake and maintenance. Many studies have shown a clear link between psychosocial stress and sleep. Psychological stress increases psychophysiological alertness, which is suspected to be the main reason why stress interferes with sleep. Worry time is a predetermined period of time that the person devotes to their worries. Worry time or worry diary has reduced sleep disturbances in some subjects.
What is worry time?
People tend to worry about things. Concern should be overcome, as it is of no use. The worry-time method is helpful for those who in bed begin to worry about their issues. The purpose is to write down the concerns or things that are on the mind by the time you go to bed. Usually, during predetermined worry time, solutions are sought to clarify the problems. If a solution cannot be found or cannot be influenced, it would be best to let time pass. It is good to read the text you write to yourself or a close person, this is how the distance and the other person’s view of things come into play. The intention is that all things are under control and things are organized under their own weight. You should set aside 15-20 minutes in the evening for this, preferably a couple of hours before going to bed.
The purpose of the sleep diary method is to monitor the effects of insomnia and treatment. The sleep diary includes information about sleep, daily activities, alertness, medication use, and health status. It is a good idea to register your sleep rhythm in your sleep diary, as well as insomnia symptoms and sleep quality. Based on these answers, the so-called sleep efficiency percentage can be calculated. In this way, the length of sleep time is also known.
Nutrition and stimulants
Diet is very important for alertness and sleep. With a good diet, we can calm our bodies and it also improves sleep and alertness. Nutrition affects energy balance and well-being.
Fast carbohydrates have a debilitating effect on sleep, as they quickly raise blood sugar, accelerating insulin production, making the body feel refreshed. Blood sugar then drops rapidly as insulin binds glucose and with it is stored in adipose tissue. This recurrent fluctuation in blood sugar impairs the quality of night sleep. The evening meal is recommended to be light and nutritious. A heavy diet has a bad effect on sleep as it can result in having difficulties in falling asleep.
It is not recommended to eat very greasy and spicy foods in the evening.
Sleep and nutrition: Nicotine
Nicotine has an effect on the central nervous system. It induces refreshment primarily by stimulating cholinergic neurons in the lower part of the brain and through nicotinic receptors in the acetylcholine system. It also affects the levels of neurotransmitters, increasing them. Through the nicotinic receptor, dopamine, called pleasure hormone, is released. According to sleep hygiene recommendations, nicotine should be avoided to get better sleep, as it reduces intermittent sleep and makes it easier to fall asleep.
Studies show that smoking or using a nicotine patch, for example, is associated with impaired sleep. Nicotine works by prolonging the time to fall asleep, reducing total sleep time and suppressing both REM sleep and slow-wave sleep. Quitting smoking is recommended, even if withdrawal symptoms cause sleep problems due to mental emotions.
Sleep and nutrition: Caffeine
Coffee is the most widely used psychoactive stimulant of all and its stimulating effects make it a logical target in the search for sleep-disrupting factors. At the molecular level, caffeine blocks adenocin receptors in the basal brain and hypothalamus.
Caffeine reaches its peak concentration in about 30 minutes after oral ingestion. Its half-life is 3-7 h, but is influenced by individual factors such as sensitivity, metabolism and accumulation. The half-life of caffeine increases with age, meaning that in older adults the substance remains active for longer. Laboratory studies have shown that large amounts of ingested caffeine near bedtime cause fragmented sleep. But at the lowest doses of caffeine, the effects are smaller and less consistent. There are few long-term studies on caffeine abstinence, but the available information suggests that it would be desirable for individuals who use it little or intermittently. Further research is needed into the effects of high levels of caffeine on the human body.
Sleep and nutrition: Alcohol
Alcohol stimulates the GABA, cannabinoid and opiate systems in the central nervous system, creating an effect on pleasure through this. It is known that alcohol may deepen sleep and reduce the amount of REM sleep from the beginning of the night, but towards the end of the night the amount of REM sleep and nocturnal awakenings increase. Alcohol consumption close to bedtime is associated with prolonged falling asleep time and increased slow-wave sleep as alcohol is metabolized after the first few hours of sleep, sleep becomes lighter, and N1 and REM sleep levels increase. In addition, there will be more frequent night awakenings.
Sleep problems can predispose to alcohol problems. In alcohol addicts, sleep problems are chronic, exacerbated by withdrawal symptoms. Therefore, there is not much information on the effectiveness of sleep hygiene recommendations. There are also not enough studies on the concomitant use of alcohol and other stimulants, substances such as tobacco, caffeine and energy drinks, and their effects on sleep.
Relaxation methods as a drug-free treatment for insomnia
The main cause of insomnia may be a state of wakefulness in the body due to the busy lifestyle of modern society. The means of relaxation aim to calm the mind, body and environment. Relaxation has been found to work in the same way as sleep, as both calm the mind and body functions. The relaxation of the autonomic nervous system is reflected throughout the body through the endocrine system and the immune system. The body’s neurotransmitter system begins to secrete e.g. oxytocin, which acts like morphine and relieves stress.
By experimenting with relaxation techniques, you will find the most suitable option for yourself. These include e.g. progressive relaxation, breathing exercises and mindfullness. It can take time to train them, but practicing relaxation may help you get your sleep.
Relaxation as a drug-free treatment for insomnia
In the treatment of insomnia, good results have been obtained through relaxation. Progressive muscle relaxation is a good method. Gradual progressive muscle relaxation, alternating with conscious muscle tension and relaxation, has been found to reduce anxiety and increase relaxation. Relaxation therapy helps with both sleep and sleep maintenance. When relaxation is incorporated into daily life, exercises produce long-term positive results. This also initially requires practice and regularity. Relaxation is both physical and mental. It helps to recover quickly from physical and mental performance. It increases stress management, concentration, and self-awareness, which is why it helps with insomnia.
Suggestion, or state of relaxation, is used as an aid and it affects thoughts and feelings of the whole body so that the body relaxes. While autogenic relaxation occurs through thoughts, paying attention to each muscle group one at a time, as well as muscle management. The purpose is for the whole body to relax. Studies show that different relaxation techniques may have positive effects on sleep.
Breathing exercises as a drug-free treatment for insomnia
Breathing exercise techniques are diverse and are designed to calm the autonomic nervous system. The first thing to learn is deep breathing. Its purpose is to bring help in panic states or loss of control. Often in these situations, you should calm yourself down by breathing in and out calmly three or five times. You can calm your mind by telling yourself that I have nothing to worry about. Breathing exercises can be done regardless of place or time. Abdominal breathing is often used as part of various relaxation techniques or can be used alone.
Mindfullness as a drug-free treatment for insomnia
Mindfullness is the presence and focus of the moment. Awareness skills exercise provides a good foundation for sleep. Exercises help get negative things out of thoughts and create a relaxed living space from comfortable memories. The purpose is to liberate the mind and allow oneself not to focus on anything. Mindfullness meditation is a new approach to managing stress and emotions that are beneficial for sleeping. There is statistical and clinical evidence that falling asleep time is shortened and easier.
Image training as a drug-free treatment for insomnia
Every person uses imaginative exercise in their daily life, e.g., imagining a driving route to a travel destination before starting to drive. This imagination makes driving easier. Imagination training in facilitating falling asleep access aims to control distracting thoughts and worries. This can help stop the flow of negative thought patterns, worries and emotions. During the imagination exercise, the mind focuses on other things, such as visualized images. This is especially effective for thoughts that come from anxiety. Studies show that meaningful and relaxing or symbolic imagery makes it easier to reduce worries and body hyperactivity.
Music as a drug-free treatment for insomnia
Music plays a major role in the drug-free treatment of insomnia. The best results are obtained when the subjects have listened to music before going to bed. Music-assisted relaxation has been found to be most relevant to sleep quality. Listening to music and music-assisted relaxation will help shorten your time to fall asleep. Listening to music can also have an effect on sleep efficiency.
The type of music listened to had differences between different studies. Others stated that relaxing and soothing music should be listened to while lying on the bed, while others found that familiar favorite music had an increased therapeutic effect. In any case, all the studies revealed the positive therapeutic effects of music.