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Relaxation techniques and sleep hygiene for insomnia

Last Update: September 24, 2013; Next update: 2016.

Nearly one out of five people have trouble with insomnia for a time. It is often difficult to say why someone is sleeping poorly. Using relaxation techniques and changing sleeping habits can help you fall asleep faster and get more restful sleep.

Many people with insomnia want to get more sleep again without having to take sleeping pills. It can then be worth giving relaxation techniques a try or checking whether the sleep problems might be caused by certain habits, such as drinking coffee late in the evening.

One of the key goals of relaxation techniques and good "sleep hygiene" is to worry less about getting enough sleep. Lying in bed and worrying about not being able to fall asleep can actually prevent you from sleeping itself.

How do relaxation techniques work?

The aim of relaxation techniques is to achieve physical and mental relaxation. They are meant to reduce physical tension and interrupt the flow of thoughts that is preventing sleep. Studies show that people who have learned relaxation techniques sleep a bit longer at night. The main benefit of the exercises was being able to fall asleep somewhat more quickly. But relaxation techniques do not help everyone. There are different types of relaxation techniques:

  • Progressive muscle relaxation, also called Jacobson's or deep muscle relaxation: This technique involves tensing groups of muscles all over the body one by one and then consciously relaxing them again. You can learn muscle relaxation by visiting a course or using an audio training course.
  • Autogenic training (AT): Autogenic training involves focusing awareness on different parts of the body and consciously relaxing them. At an advanced level, even involuntary bodily functions like pulse and breathing can be influenced in order to try to reach very deep physical relaxation. Autogenic training can be learned in a course.
  • Biofeedback: This method helps you become aware of how your body reacts to tensing and relaxing. Electrodes are placed on your body to measure signals like muscle tension, pulse and brain activity. These signals can be followed on a screen, for example, making it possible to see how they are influenced by things like muscle relaxation or thinking particular thoughts.
  • Imagery: Another common type of relaxation training is imagery, where you visualize peaceful scenes or imagine yourself breathing quietly, gently falling asleep and having a good night's sleep.

What habits can help improve your sleep?

Studies suggest that changing your sleeping habits can help improve the quality of your sleep. People who had been informed about sleeping habits slept more peacefully and did not wake up as often. There are courses that teach you about how you can change your sleeping habits. In the studies a typical course lasted four weeks, with one session per week.

There are many different things you can do to change your sleeping habits. Some of the more common ones are listed below. But it is difficult to tell from the research which of them is likely to work best.

Sleep hygiene

The following set of “sleep hygiene” habits could have a positive effect:

  • Not drinking alcohol, coffee or tea and avoiding other stimulants four to six hours before going to bed.
  • Avoiding smoking before bedtime or during the night.
  • Avoiding large meals and very spicy foods before going to bed.
  • Getting more physical exercise during the day, but avoiding strenuous exercise right before going to bed.
  • Trying to make sure your bedroom is quiet and dark. It should be at a comfortable temperature.
Illustration: Sleep hygiene: Tips for sleeping better

Sleep hygiene: Tips for sleeping better

Stimulus control

Stimulus control is designed to help improve the sleep-wake cycle by creating a strong association between the person's bed and sleeping. A fixed schedule and specific bedtime habits are needed. For instance:

  • Making it a basic rule to only go to bed when you feel tired.
  • Getting up if you are having difficulty falling asleep (again).
  • Only using your bed for sleeping (or sex), and not for reading, watching TV or eating.
  • Always getting up at the same time in the morning.

Limiting sleep time

This approach aims to restrict the time you spend in bed to the time when you are actually asleep. For example, if you usually lie in bed for eight hours, but only sleep six hours, then the idea is that you should only spend six hours in bed. Making adjustments could help you find the optimum length of time to spend in bed in order to get a good night's sleep.

What can cognitive behavioral therapy do?

The aim of cognitive behavioral therapy (CBT) is to change thought patterns that may be keeping you from sleeping. This is not the same as "positive thinking." Instead, it is about changing exaggerated, unrealistic beliefs about sleep. For example, if someone believes that they will always wake up at three in the morning and then not be able to go back to sleep, it may turn into a "self-fulfilling prophecy."

Another example of a negative thought that can affect sleep is: "If I don't fall asleep now I definitely won't make it through tomorrow." A more realistic thought might be: "This happens from time to time. But I might still get some sleep. And it's no big deal if I don't."

A more realistic attitude towards sleep also includes not worrying about how much sleep you end up getting. It is more important that your sleep is restful enough for you to feel good the next day.

When cognitive behavioral therapy is used for sleep problems, it is combined with other approaches like relaxation techniques or improving sleep hygiene.

Can napping during the day help?

There are conflicting theories and research results about whether it is a good or bad idea to nap during the day. Some studies have looked at whether napping during the day can make up for not getting enough sleep at night - so that you are able to drive more safely, for example. Other research has looked into whether napping helps you sleep better at night, or means that you will sleep less well instead. There are no clear results yet. As with many sleep-related matters, you will probably have to try out a few things yourself to find out what works best for you.

Sources

  • Agency for Healthcare Research and Quality (AHRQ). Manifestations and management of chronic insomnia in adults. June 2005 [Accessed on: July 25, 2005] (Evidence Report/Technology Assessment; Band 125).
  • Mitchell MD, Gehrman P, Perlis M, Umscheid CA. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Pract 2012; 13: 40. [PMC free article: PMC3481424] [PubMed: 22631616]
  • Ruggiero JS, Redeker NS. Effects of napping on sleepiness and sleep-related performance deficits in night-shift workers: a systematic review. Biol Res Nurs 13.02.2013 [Epub ahead of print]. [PMC free article: PMC4079545] [PubMed: 23411360]
  • Yang PY, Ho KH, Chen HC, Chien MY. Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. J Physiother 2012; 58(3): 157-163. [PubMed: 22884182]
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

© IQWiG (Institute for Quality and Efficiency in Health Care)

IQWiG (Institute for Quality and Efficiency in Health Care)

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