What happens when you follow all the lifestyle recommendations for sound sleep, like turning off the TV and cutting out the coffee, but you still can’t get a good night’s sleep?
Some new evidence indicates that good sleep hygiene like not napping and relaxing before bed work for the average person having about of sleeplessness but don’t work for many chronic insomniacs (who may be people with unusually high levels of stress hormones).
Science of sleep
Experts say that sleep hygiene should be considered the foundation of a good night’s sleep for everyone. Good sleep hygiene habits include controlling the bedroom environment (dark, quiet and cool is best), exercising in the day, avoiding caffeine and nicotine, restricting alcohol, winding down an hour before bed, keeping a consistent bed and wake time, and avoiding liquids.
For those with chronic insomnia, following proper sleep hygiene guidelines is not going to cure the problem. While good habits still need to be followed, the addition of other treatments can prove beneficial.
There are different treatment approaches that can be effective for insomnia, and discussing the options with your doctor may help you decide the most appropriate course. If you have tried various treatments and are still not making much improvement, you should ask for a referral or seek out a sleep specialist.
One option, not widely known, is cognitive-behaviour therapy for insomnia, or CBT-I. This approach may be particularly useful for those who prefer not to take medications to help them sleep.
It is an evidence-based, nondrug, short-term (usually four to eight sessions) therapy based on the concept that chronic insomnia is maintained by a number of physical and behavioural factors. These factors then become the focus of treatment.
Therapy includes education about what can interfere with sleep, sleep hygiene measures, individualised sleep-wake scheduling programs, elimination of sleep-incompatible behaviours (like watching TV), relaxation training and identification of challenging thoughts that can meddle with sleep.
It is considered by many specialists to be a first-line treatment for insomnia. Patients who have anxiety, depression or psychotic disorders may need treatment with psychiatric medications. Sedating antianxiety medications, antidepressants or antipsychotic medications may be helpful in such cases.
When medication is used, good sleep hygiene and some behavioural treatments are still important, as utilising either behavioural or medication treatments alone are not enough. Some patients benefit from a combination of both cognitive-behaviour therapy and medication, and even choose to begin both treatments simultaneously.
As sleep improves, they are slowly weaned off the medication while shifting focus solely to behavioural methods to maintain good sleep.