Alternatives to formal cognitive behavioral therapy for insomnia
| Online apps and self-help books Online resources include books patients can read on their own and apps that guide patients through cognitive behavioral therapy for insomnia |
| Brief therapies for insomnia Abridged versions of cognitive behavioral therapy that emphasize behavioral aspects of sleep regulation |
| Education is given on sleep hygiene, factors that affect sleep, and principles of sleep restriction (described below) |
| After examining a sleep diary, primary care clinicians can inquire about the patient’s sleep habits and provide education on patient-specific factors that may be affecting sleep (eg, excess alcohol, using screens in bed, attempting to go to bed too early) |
| Sleep-restriction therapy Aims to limit a patient’s time in bed to when asleep |
| Patients are asked to limit their time in bed to their average sleep time, go to bed only when sleepy, get up if they cannot fall asleep, and return to bed only once sleepy: the idea is that most of the time spent in bed is sleeping |
| Gradually the time spent in bed is increased as sleep duration and quality improve |
| Stimulus control The idea is to extinguish the association between the bed and wakefulness |
| Patients should be instructed to use the bed only for sleep and sex, establish a consistent bedtime and waking time, go to bed only when sleepy, get out of bed if unable to sleep, and refrain from daytime naps |
| Relaxation therapies Includes exercises designed to decrease tension, eg, deep breathing, abdominal breathing, progressive muscle relaxation, and meditation |
| A variety of applications can be used for guided meditation and relaxation |
Based on information in references 5, 12, and 18.