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Medical Author:

Siamak T. Nabili, MD, MPH

Siamak T. Nabili, MD, MPH

Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Non-pharmacologic or non-medical therapies are sleep hygiene, relaxation therapy, stimulus control, and sleep restriction. These also are referred to as cognitive behavioral therapies.

Sleep Hygiene

Sleep hygiene is one of the components of behavioral therapy for insomnia. Several simple steps can be taken to improve a patient's sleep quality and quantity. These steps include:

• Sleep as much as you need to feel rested; do not oversleep.
  
  
• Exercise regularly at least 20 minutes daily, ideally 4-5 hours before your bedtime.
  
  
• Avoid forcing yourself to sleep.
  
  
• Keep a regular sleep and awakening schedule.
  
  
• Do not drink caffeinated beverages later than the afternoon (tea, coffee, soft drinks etc.) Avoid "night caps," (alcoholic drinks prior to going to bed).
  
  
• Do not smoke, especially in the evening.
  
  
• Do not go to bed hungry.
  
  
• Adjust the environment in the room (lights, temperature, noise, etc.)
  
  
• Do not go to bed with your worries; try to resolve them before going to bed.

Relaxation Therapy

Relaxation therapy involves measures such as meditation and muscle relaxation or dimming the lights and playing soothing music prior to going to bed.

Stimulus Control

Stimulus control therapy also consists of a few simple steps that may help patients with chronic insomnia.

• Go to bed when you feel sleepy.
  
  
• Do not watch TV, read, eat, or worry in bed. Your bed should be used only for sleep and sexual activity.
  
  
• If you do not fall asleep 30 minutes after going to bed, get up and go to another room and resume your relaxation techniques.
  
  
• Set your alarm clock to get up at a certain time each morning, even on weekends. Do not oversleep.
  
  
• Avoid taking long naps in the daytime.

Sleep Restriction

Restricting your time in bed only to sleep may improve your quality of sleep. This therapy is called sleep restriction. It is achieved by averaging the time in bed that the patient spends only sleeping. Rigid bedtime and rise time are set, and the patient is forced to get up at the rising time even if they feel sleepy. This may help the patient sleep better the next night because of the sleep deprivation from the previous night. Sleep restriction has been helpful in some cases.

Other simple measures that can be helpful to treat insomnia include:

• Avoid large meals and excessive fluids before bedtime
  
  
• Control your environment.
  
  
  • Light, noise, and undesirable room temperature can disrupt sleep. Shift workers and night workers especially must address these factors. Dimming the lights in the bedroom, relaxation, limiting the noise, and avoiding stressful tasks before going to bed may be beneficial. (Refer to sleep hygiene and relaxation therapy above.)
    
    
  • Avoid doing work in the bedroom that should be done somewhere else. For example, do not work or operate your business out of your bedroom and avoid watching TV, reading books, and eating in your bed.

A person's circadian rhythm (biological clock) is particularly sensitive to light. Parents who need to sleep during the day may have to make child care arrangements to allow them to sleep.

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