Insomnia Treatment Recommendations



Schedule.Consistent bedtime and wake time.

Time in bed. Avoid excess time in bed. Thus, don’t go to bed too early before routine time. If sleep onset has not occurred within about 30 minutes, get out of bed and do some low activity tasks such as cleaning a drawer, reviewing magazines and catalogs to select a few articles/items and throw most out, read something that is not stimulating, watch television in another room, or similar activities. Return to bed in about 30 minutes and use relaxation and cognitive techniques to help return to sleep.

Competing and interfering activities in bedroom. Activities to avoid in bed and bedroom include TV, laptop computer, other office/work type activities, discussions of  upsetting topics, arguing, and worrying. All of this can be done in other rooms.

Trying to sleep. Avoid saying to yourself that you must start sleeping fast or being upset that sleep is not starting. Use physical and mental relaxation techniques.

Thoughts in bed including when trying to start and resume sleeping. Avoid worrying in bed. Avoid problem solving in bed. Avoid thinking about your day, other people, work, and the next day. It is natural to have some thoughts like these but ideally only for a few minutes at most. Shift your thoughts and focus to relaxation techniques. If the thoughts continue for more than about 15 minutes, get out of bed and go to another room, write or type some of your thoughts if you need to remember them or solve a problem, but shift away from these when you return to bed.

Clocks: Hide all bedroom clocks after setting morning awake alarm.

Exercise. Avoid vigorous exercise within a few hours, probably 4 to 6 hours, before bedtime. Vigorous aerobic exercise for at least 20 to 30 minutes a day is good but earlier in the day. For people with insomnia, exercise increases stress hormones and thus hyperarousal. After several hours the rebound effect lowers the arousal lower than if you had not exercised.

Caffeine.  Avoid caffeine for at least 12 hours before bedtime thus about noon or earlier. Minimize amount of caffeine even in morning.

Alcohol.  Avoid alcohol in evening.

Nicotine. Avoid cigarettes.

Medications. Be sure your medications are not contributing to your insomnia such as with stimulants.

Pain. Relieve pain that could be interfering with sleep.

Relaxation. Use relaxation procedures at bedtime in bed. Avoid muscle tension-release procedures. Try warm bath or shower, light snack before bed, and/or massage.

Naps. Avoid names if possible. If you must nap, limit nap sleep to 30 minutes or less. For example, avoid naps within about 8 hours of bedtime.

Sleep interruptions. Avoid noise. Try low level background sounds such as from a fan, airconditioner, or humidifier. Use earplugs if needed.

Room temperature. Keep temperature cooler than daytime.

Bedroom darkness.  Use blackout curtains or eye covers if needed.

Mattress and pillow. Use a comfortable mattress and pillow

Bedtime routine.  Wind down in the last couple of hours before bedtime. Avoid excess physical and mental stimulation.

Sexual activity. Satisfying activity is better than frustrating activity.

Excess daytime sleepiness.  Minimize excess daytime sleepiness. Check this daily as below.

Resources/References
  http://mayoclinic.com/health/sleep/HQ01387  http://mayoclinic.com/health/insomnia/DS00187

Epworth Sleepiness Scale
Test yourself for excess daytime sleepiness. Ask yourself: How likely would you doze off or fall asleep in the following situations? This is different from just feeling tired.

Use this rating scale:
  3 = high chance of dozing,
  2 = moderate chance of dozing,
  1 = slight chance of dozing,
  0 = would never doze.

Situation
(0-3)
Sitting and reading ………………………………………………… ___
Watching television ………………………………………………… ___
Sitting inactive in a public place such as a theatre
or meeting ………………………………………………………………… ___
As a passenger in car for an hour without a break …… ___
Lying down to rest in the afternoon ……………………………….. ___
Sitting quietly after lunch
(when you’ve had no alcohol) …………………………………………. ___
In a car, while stopped in traffic …………………………………… ___

Add the numbers. If your score is 10 or more you have excess daytime sleepiness. You need to be extra careful driving and might need to avoid driving and other risky activities.