09/26/2018
Insomnia: Relaxation techniques and sleeping habits
Last Update: March 9, 2017; Next update: 2020.
Nearly one out of five people sometimes have trouble with insomnia. 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 and checking whether the problems might be caused by certain habits, such as drinking coffee late in the evening. It is also important to not worry too much about how much sleep you get. Lying in bed and worrying about not being able to fall asleep can actually prevent you from sleeping.
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 thought processes that are affecting sleep. Studies show that people who have learned relaxation techniques sleep a bit longer at night. The main benefit of the relaxation techniques was being able to fall asleep somewhat more quickly. But these approaches don't 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 to achieve deep physical relaxation. Autogenic training is taught in courses.
Biofeedback: This method helps you to feel how your body reacts to tensing and relaxing. It involves placing electrodes on your body to measure muscle tension, your pulse and brain activity. You can monitor these different measurements on a screen and see how muscle relaxation or thinking particular thoughts affects them. Biofeedback can be done at the doctor's or by using a portable biofeedback device at home once you've been instructed in how to use it.
Imagery (visualizations): Another common type of relaxation training is imagery, where you visualize peaceful, pleasant 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 instructed about sleep habits slept more peacefully and didn't wake up as often. There are courses that teach you about how you can change your sleeping habits. In these 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. Here we list some of the more common ones. But it is difficult to tell from the research which of them are most likely to work.
Sleep hygiene
The following set of “sleep hygiene” habits can 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 heavy meals and spicy foods before going to bed.
Getting more physical exercise during the day, but avoiding exercise right before going to bed.
Trying to make sure your bedroom is quiet, dark and not too hot or cold.
Illustration: Sleep hygiene: Tips for sleeping better
Sleep hygiene: Tips for sleeping better
Stimulus control
The aim of stimulus control is 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:
Make it a basic rule to only go to bed when you feel tired.
Get up if you are having difficulty falling asleep (again).
Only use your bed for sleeping (or s*x), and not for reading, watching TV or eating.
Always get up at the same time in the morning.
Limiting sleep time (Sleep restriction therapy )
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 not spend more than six hours in bed.
First you see how much sleep you get on average over a period of about two weeks. It may help to keep a sleep diary. Another half an hour of time spent falling asleep is added to the average sleeping time. That's the time between "lights out" and actually falling asleep. The best time for you to go to sleep is then calculated "backwards," using your wake-up time as the starting point: For instance, if your alarm is set for 6:00 a.m. and you need six hours' sleep as well as half an hour to fall asleep, you would go to bed at 11:30 p.m. Adjustments like these 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?
Cognitive behavioral therapy (CBT) aims to change thought patterns that may be keeping you from sleeping. This is not the same as "positive thinking." 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's more important that your sleep is restful enough for you to feel good the next day.
When treating insomnia, cognitive behavioral therapy methods can be combined with other approaches, such as relaxation techniques and better sleep hygiene.
Even if you don't have cognitive behavioral therapy, you can still examine your own thinking and try to change negative thought patterns. That could help to get rid of thoughts that are keeping you from sleeping.
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, helping you to drive more safely, for example. Other researchers have studied whether napping helps you sleep better at night or perhaps even has the opposite effect, making you sleep worse at night instead. There are no clear results yet. As with many questions about sleep, you will probably have to try out a few things first to find out what works best for you.
Sources
Brasure M, MacDonald R, Fuchs E, Olson CM, Carlyle M, Diem S et al. Management of Insomnia Disorder. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015. (AHRQ Comparative Effectiveness Review; Volume 159).
Ruggiero JS, Redeker NS. Effects of napping on sleepiness and sleep-related performance deficits in night-shift workers: a systematic review. Biol Res Nurs 2014; 16(2): 134-142 [Epub ahead of print]. [PMC free article] [PubMed]
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]
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