7 expert-recommended strategies for getting a good night's sleep

Sad tired frustrated


BI Answers: I have a terrible time falling asleep. Is there anything I can do to sleep better?

It’s already hard to get enough sleep in our busy, wired, non-stop culture — 40% of people sleep less than the recommended seven to nine hours a night.

Insomnia makes it so much worse.

Between a third and half of all adults in the US and around the world suffer from insomnia at some point in their lives, making it the most common known sleep disorder in the world.

In up to 15% of people, this inability to sleep is persistent enough that it causes serious distress. The lack of sleep not only affects day-to-day memory and focus, but also makes people more likely to suffer from depression and is associated with a host of other issues.

But there’s hope!

According to the American Academy of Sleep Medicine, insomnia can be treated — effectively, and without drugs or so-called “natural” remedies like melatonin and valerian root. (While experts say certain hypnotic drugs can occasionally be used in the short term, they say it’s best to switch to behaviour altering strategies as soon as possible.)

Some types of insomnia, for example, are actually caused by external factors, like a hostile sleep environment (a bright loud room) or a substance-abuse problem (if you can’t fall asleep without a drink, you should consider talking to your doctor). These are cases of “secondary insomnia,” and they can often be remedied simply by finding a solution to the external troubling factor.

In cases of “primary insomnia,” however, where sleeplessness isn’t being caused by a secondary source, being unable to sleep can result in a vicious cycle where being unable to sleep makes someone angry or frustrated, which in turn makes it even tougher to sleep. In those cases, breaking the cycle is key.

There’s no one best strategy — what works for one person might not be the best option for another. But here are seven sleep-aiding strategies that experts say work. We’ve ranked them according to how well they have been shown to work in scientific studies.

Best evidence: The 3 following strategies have been shown to work in randomised well-designed studies.

1. Stimulus control therapy. The chronic inability to sleep is horribly frustrating, and people who start to face the night with dread and stare at their clocks until it’s time to get up start to develop negative emotions like fear, anxiety, and anger that they associate with trying to sleep.

Stimulus-control therapy seeks to break those associations, so you simply associate bed with sleep (and not all that extra baggage). Doctors recommending this approach will suggest things like not keeping a clock in bedroom and not lying in bed when you can’t sleep.

The Ohio Sleep Medicine Institute recommends that “patients should not ‘catastrophize’ when faced with a ‘bad night.'” Instead of worrying about how awful your day is going to be because you are tired, realise that you may be better able to sleep the next night because of it.

2. Relaxation training. When you’re anxious about being unable to sleep, your body produces stress hormones that make it harder to let go of that anxiety.

Training yourself to relax using a technique like progressive muscle relaxation (individually focusing on relaxing every part of your body in sequence) or meditation can help.

3. Cognitive behavioural therapy. This is a two-part strategy. The cognitive part includes changing people’s beliefs about their insomnia. In many cases, people who are stressed about their inability to sleep tend to exaggerate the problem, thinking they have slept even less than they actually have. Changing these negative thoughts can reduce some of the distress.

For altering behaviour, experts recommend combining both the relaxation training and stimulus control therapy described above. Creating an environment conducive to sleep, like a cool dark quiet room, can help too.

Good evidence: Enough studies have shown that these strategies work to say they are effective, though they haven’t been as thoroughly tested as the recommendations above.

4. Sleep restriction. This strategy is simple — if you can’t sleep, don’t lie in bed and try to fall asleep.

If you’ve been trying for more than 20 minutes, get out of bed and go do something else. Don’t use your computer, phone, or watch TV though — those can all make sleep problems worse.

Experts say that staying out of bed when you can’t sleep helps break the cycle of linking your bed with negative emotions. Plus, the mild sleep deprivation this causes could make it easier to sleep the next day.

5. Behavioural therapy. Just doing the stimulus control therapy described in #3 and adding relaxation training and a better sleep environment can be effective too. Give it a try.

6. Not trying to fall asleep. As funny as this may sound, the trick to falling asleep might be trying to stay awake.

By lying in bed content to be awake and not worrying about falling asleep, insomniacs have been shown to actually fall asleep more quickly and sleep better. Experts say this is because trying to stay awake (without looking at phones or computers and just doing nothing) removes the anxiety people can feel while trying to fall asleep.

7. Biofeedback. Therapists often use biofeedback to help patients manage stress, and it can work for insomnia too. This involves learning how to recognise stress symptoms like an elevated heart rate, muscle tension, and rapid breathing, and then focusing on bringing those stress symptoms back to a normal level.

If you have trouble sleeping, give one or several of these strategies a try. Getting better sleep can change your life.

This post is part of a continuing series that answers all of your questions related to science. Have your own question? Email [email protected] with the subject line “Q&A”; tweet your question to @BI_Science; or post to our Facebook page.

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