From the Harvard Health Publications Special Health Report, Improving Sleep: A Guide to a Good Night’s Rest. Copyright 2005 by the President and Fellows of Harvard College.
What to Do About Insomnia
For chronic insomnia, the treatment of choice is to change your lifestyle and habits. A careful evaluation can pave the way to better sleep by pinpointing habits that keep you up at night. A sleep specialist trained in behavioral medicine can help people with learned insomnia replace their bad habits with positive ones.
People with insomnia often find that spending less time in bed promotes more restful sleep and helps make the bedroom a welcome sight instead of a torture chamber. As you learn to fall asleep quickly and sleep soundly, the time in bed is slowly extended until you obtain a full night’s sleep.
Some sleep experts suggest starting with five or six hours at first, or whatever amount of time you typically sleep at night. Setting a rigid early morning waking time often works best. If the alarm is set for 7 a.m., a five-hour restriction means that no matter how sleepy you are, you must stay awake until 2 a.m. Once you are sleeping well during the allotted five hours, you can add another 15 or 30 minutes, then repeat the process until you’re getting a healthy amount of sleep.
In the 1970s, a Northwestern University professor developed a technique to recondition people with insomnia to associate the bedroom with sleep. These are the rules:
- Use the bed only for sleeping and sex.
- Go to bed only when you’re sleepy. If you’re unable to sleep, get up and move to another room. Stay up until you are sleepy, then return to bed. If sleep does not follow quickly, repeat.
- During the reconditioning process, get up at the same time every day and do not nap.
The idea is to train your body to associate your bed with sleep instead of sleeplessness and frustration.
For some people with insomnia, a racing or worried mind is the enemy of sleep. In others, physical tension is to blame. Fortunately, there are ways to release physical tension and relax more effectively. Relaxation techniques that can quiet a racing mind include meditation, breathing exercises, and progressively tensing and relaxing your muscles starting with your feet and working your way up your body — a technique known as progressive muscle relaxation.
In biofeedback, people use equipment that monitors and makes them aware of involuntary body states (such as muscle tension or hand temperature). Immediate feedback helps people see how various thoughts or relaxation maneuvers affect tension, enabling them to learn how to gain voluntary control over the process. Biofeedback is usually done under professional supervision. Other relaxation techniques — such as progressive muscle relaxation or meditation — can be learned in behavior therapy sessions or from books, tapes, or classes.