The Covid pandemic has made us more stressed and sleepless. Even as more people turn to pills, psychologists say we can treat insomnia without medication and get back to sleeping well again.
Insomnia is both a symptom and an illness.
The word “insomnia” originates from the Latin “in” (no) and “somnus” (sleep). However, insomnia is not just “no sleep” or “not getting enough sleep” — it can also mean sleep that doesn’t rejuvenate you.
- The American Sleep Association points out insomnia as the most common sleep disorder among American adults, affecting 50-70 million people.
- 30% of all adults experience short-term or transient insomnia, lasting a few days to a few weeks.
- 10% have long-term or chronic insomnia, lasting more than a month (Franzen, et al., 2008).
But then begins a journey in my head— William Shakespeare, Sonnet 27
To work my mind, when body’s work’s expired …
What Do We Mean By Insomnia?
Insomnia is defined as DIMS, that is, Difficulty in Initiating And Maintaining Sleep. It is more common in divorced, separated, widowed, older, White, and female gender people. Psychological factors, like worry, anxiety, stress, depression, behavioral habits, mental trauma, and overthinking or rumination, are its primary causes.
According to Carney & Berry (2005), insomnia means one or more of the following symptoms:
- difficulty falling asleep while being in bed,
- waking up frequently during the night,
- having trouble falling back asleep after waking,
- waking up too early in the morning, or
- having an unrefreshing (non-restorative) sleep.
In fact, it was the first psychosomatic disorder to be identified, by Johann Heinroth in 1818.
Insomniacs are more likely to suffer from depression, anxiety, substance abuse, suicide, and immune illnesses (Taylor, et al., 2003). They have higher workplace accidents and more fatal road accidents.
Childhood and adolescent insomnia can predict generalized anxiety disorder and depression, later in life (Shanahan, et al., 2014).
Chronic insomnia can ruin your relationships. People with poor sleep have poor relationships. They have irritable moods, scattered focus, and constant fatigue. The mental and physical exhaustion makes them miss the cues to what people expect from them. It also makes them overpromise and underdeliver.
How Medications Can Harm: Hypnotic medications (sleeping pills) are effective in the short term but addicting in the long term. They can cause headaches, hallucinations, nightmares, and Alzheimer’s disease. They can worsen sleep apnea and raise the risk of death. Most over-the-counter medicines, like antihistamines, make you sleepy but do not help you fall asleep.
How To Treat Insomnia Without Medications?
Medications for insomnia are undeniably helpful, but they work best for short-term relief and ignore the underlying causes of the sleep problem.
Insomnia can also be treated with “non-pharmacologic” or “non-drug” treatments based on data from scientific research. In fact, the first method below is the best treatment for insomnia in adults.
Here below are some science-based ways to treat insomnia without drugs:
1. Cognitive Behavioral Therapy For Insomnia (CBT-I)
In February 2021, an AASM task force of experts in sleep medicine and sleep psychology regarded Cognitive Behavioral Therapy For Insomnia (CBT-I) as the treatment of choice and the best treatment currently available for chronic insomniacs.
CBT-I is a multicomponent therapy including cognitive techniques, education on stimulus control, sleep restriction, relaxation, sleep hygiene literacy, and other counter-arousal methods.
It is a time-limited treatment, as opposed to medications that must be used for years.
With fewer side effects than drugs, higher long-term effectiveness, and better symptom improvement, CBT-I helps overcome insomnia for the longest time after the end of therapy.
According to AASM, CBT-I is the most effective and evidence-based therapy that we currently have for treating chronic insomnia.
Of course, the effectiveness of any insomnia treatment is measured by remission rate, responder rate, sleep quality, sleep latency, and wake after sleep onset. The CBT-I therapy scores well on all these as compared to medications.
Still, it’s not perfect. There are 4 major issues of CBT-I:
- First, CBT-I is typically provided by mental health professionals, that is, clinical psychologists and cognitive behavioral therapists trained in it. So, it is not easily available as there aren’t many trained specialists.
- Second, it comes at a higher out-of-pocket cost than medications. This is a serious drawback of accessing it.
- Third, it produces slow improvements in symptoms, though the benefits last long after the treatment is over. The usual CBT-I treatment takes an initial assessment, followed by 6-8 follow-up sessions.
- Fourth, it has two early negative effects: sleepiness and fatigue. However, according to the available data, for the majority of therapy takers, these are typically mild and resolve quickly.
The National Institute for Health and Care Excellence (NICE) formally recommends only CBT-I and pharmacological treatment for insomnia.
2. Stimulus Control For Insomnia
Stimulus control includes behaviors that are designed to dissociate the bed or bedroom from wakeful activities, associate the bed or bedroom with sleep, and establish a consistent wake-time.
Stimulus control conditions your brain (like Pavlov’s dogs or Seligman’s dogs) to instinctively link your bed with no activity apart from sleep (and intimacy). As a result, whenever you are in your bed, you tend to fall asleep fast.
Therefore, when in your bed, do not eat, read stuff from work, watch TV, play games, be on social media, do online activities, or make strategies like to-do lists. Ideally, if you have a separate bedroom, do not enter the bedroom unless it is time for sleep (or intimacy).
Here’s how to practice stimulus control:
- Use bed or bedroom for only sleep (and intimacy).
- Go to bed only when you are sleepy-tired.
- Wake up at the same time every morning.
- Try to avoid daytime naps.
- Get out of bed if unable to sleep for 20 minutes or so.
Rather than painfully staying in bed when sleep is not happening, experts say it is better to get out of bed and move to another room.
Do something light and gentle, like reading a paper book or listening to a podcast. Return to bed when you start to feel sleepy-tired.
Strictly refrain from anything that needs staring at a blue-light screen, like reading an e-book or watching a movie on your mobile. Avoid lying down on a sofa, as it can make you fall asleep there.
3. Sleep Restriction Therapy For Insomnia
Sleep restriction involves reducing the total time spent in bed.
- Restrict your time in bed to your average sleep duration. Initially, it may mean getting even less sleep than normal.
- Start experimenting with delaying your bedtime while keeping the wake time the same every morning.
- After a few weeks, you may increase or decrease it to achieve sufficient duration and overall sleep satisfaction.
Sleep restriction increases the biological pressure to sleep, resulting in less time to fall asleep and more consolidated sleep.
Sleep restriction therapy is contraindicated in those who work in high-risk occupations, like heavy machinery operators or drivers, those who are susceptible to mania or hypomania, and those who have poorly controlled seizure disorders.
4. Relaxation Therapy For Insomnia
Relaxation therapy is low cost and requires minimal resources. Moreover, most well-informed patients choose relaxation therapy as a treatment for chronic insomnia disorder.
Mindfulness-based therapies can be used to treat chronic insomnia.
Mindfulness practice emphasizes attaining a nonjudgmental state of heightened awareness. It lets one notice their thoughts, emotions, and experiences on a moment-to-moment basis, without getting overly affected by them.
5. Sleep Hygiene Literacy
These are a set of lifestyle recommendations, like daily exercise, a healthy diet, avoiding substance use, and environmental factors, like noise, light, and temperature. Also includes education about age-related sleep changes.
- Avoid caffeine after 2 pm.
- Avoid or limit alcohol and nicotine, especially within 3 hours before bedtime.
- Give yourself 60-90 minutes of winding down before you go to bed every night. During the winding down period, avoid things that overstimulate the brain, like checking work emails, gaming, and social media. Do light reading, light exercise, listen to relaxing music, take a bath, and do some self-care routine.
- Keep the bed comfortable, lights dim, regulate the temperature to moderately cool, and cut off all sources of noise. Do not play relaxing music in the background; it turns into noise when trying to fall asleep.
- If you wake up at night, don’t check the time. If you have to use the toilet, do so and immediately return to bed.
- Get up at the same time every morning, even on non-working days. It strengthens your body’s natural clock (circadian rhythm or sleep-wake cycle).
- Go out to soak up the sunlight as soon as you get up. Go out even if it is a cloudy day. If you can’t go out, sit by a window.
The AASM suggests that clinicians do NOT use sleep hygiene as the ONLY therapy for the treatment of chronic insomnia in adults. They found that the potential benefits of sleep hygiene as a single-component therapy are minimal, and were no better than control conditions.
However, as AASM proposes, it can be included in multicomponent interventions like CBT-I. In fact, sleep hygiene is part of CBT-I treatment.
6. Paradoxical Intention
It involves purposefully going to bed and staying awake as long as possible. This method is said to reduce performance anxiety and conscious intent to sleep.
The AASM has NO recommendation regarding this.
Can low-light help insomnia?
Dimming the light in your room around your sleep time signals your brain to release melatonin (the sleep hormone). Exposure to blue-light screens (and also daylight) causes your brain to stop producing melatonin, causing you to be wide awake.
Is insomnia a self-fulfilling prophecy?
The insomnia patient goes to bed wanting to sleep, starts worrying about a lack of sleep, and fails to stop the racing thoughts, making it still harder to fall asleep. Thus, they complete the self-fulfilling prophecy cycle.
Insomniacs have difficulty falling asleep primarily due to worrying in bed, either about a general issue or the issue of sleep itself. In time, excessive worry about sleep becomes persistent and habituates as a nighttime trigger for anxiety and arousal.
In addition, when they fail to control their troublesome thoughts and emotions, it worsens their insomnia.
Once such a cycle is established, insomnia becomes a self-fulfilling prophecy that can persist for an indefinite time.
• To evaluate insomnia, a clinical examination that includes the patient’s history with insomnia as well as asking the patient specific questions is essential.
• For investigation, polysomnography (sleep study) is widely regarded as the gold standard for assessing sleep problems. It can detect underlying causes of insomnia, like sleep apnea (intermittent stoppage of breathing) and narcolepsy (excessive daytime sleepiness).
• Further reading: Diagnosis and treatment of chronic insomnia.
The pandemic has made more of us go sleepless. A 2021 study of sleep disturbances amid the Covid-19 pandemic found a more than 20% rise in sleeping pill use, pointing to a global surge in people reporting sleep problems.
With some self-help and professional help, you can learn how to cure insomnia quickly and are able to sleep well again.
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Want to know more on how to treat insomnia naturally without medication? Take a look at the 6 Sleep Hacks (From Science).
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Author Bio: Written and reviewed by Sandip Roy — medical doctor, psychology writer, and happiness researcher. Founder and Chief Editor of The Happiness Blog. Writes on mental health, happiness, positive psychology, mindfulness, and philosophy (especially Stoicism).
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