Once sleep apnea, narcolepsy, or other underlying medical conditions are ruled out, individuals who present with insomnia, classified as psychophysiological insomnia, can be treated with a variety of cognitive and behavioral interventions that will address the various sleep problems such as difficulty falling asleep, staying asleep, and early awakening. The patients are instructed in sleep hygiene (some examples below).
• Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime. While alcohol is well known to speed the onset of sleep, it disrupts sleep in the second half as the body begins to metabolize the alcohol, causing arousal.
• Avoid napping during the day; it can disturb the normal pattern of sleep and wakefulness.
• Exercise can promote good sleep. Vigorous exercise should be taken in the morning or late afternoon. A relaxing exercise, like yoga, can be done before bed to help initiate a restful night’s sleep.
• Food can be disruptive right before sleep; stay away from large meals close to bedtime. Also dietary changes can cause sleep problems, if someone is struggling with a sleep problem, it’s not a good time to start experimenting with spicy dishes. And, remember, chocolate has caffeine.
• Ensure adequate exposure to natural light. This is particularly important for older people who may not venture outside as frequently as children and adults. Light exposure helps maintain a healthy sleep-wake cycle.
• Establish a regular relaxing bedtime routine. Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don’t dwell on, or bring your problems to bed.
• Associate your bed with sleep and drowsiness. The first and best step you can take is to not be on your bed when you watch TV, play computer games, or read e-mails.
o If you are awake for more than 15 minutes, get out of bed. Do something nonstimulating, like reading, until you tire. Then return to bed when tired. Try to associate the bed with being pleasantly drowsy, rather than tossing and turning, upset and awake.
o Remember that sleep is a natural drive and our goal is to let our body’s need and desire for sleep take over.
• Make sure that the sleep environment is pleasant and relaxing. The bed should be comfortable, the room should not be too hot or cold, or too bright.
It is helpful to practice a relaxation technique, such as meditation. a breathing method or progressive muscle relaxation, to help clear arousing thoughts from your mind and focus on neutral ideas that will facilitate sleep.