Basic Behavioral Treatment of Insomnia & Good Sleep Hygiene

Andrew C. Peterson MD, FAASM

  1. Keep a regular bedtime and wake-up time whether or not you sleep well
  2. No more than 8 hours in bed total (adult), 9.5 hours (teen), 10.5 hours (adolescent)
  3. No naps
  4. Exercise 20 - 30 minutes every day, preferably in the morning or afternoon.
  5. Sunshine exposure when you first get up will help "set your internal clock" and improve sleep onset at bedtime.
  6. No caffeine within 6 hours of bedtime.
  7. No alcohol within 4 - 6 hours of bedtime. Try to minimize or avoid alcohol.
  8. 30 min before bed turn off the TV and all electronics, stop reading and make a Worry List.
  9. Write down anything that pops into your head, things to do, etc.
  10. After making the list, go through each item one at a time and decide what you are doing and when you are doing it about each thing.
  11. You may relax, have a cup of herbal tea or warm milk, pet the dog or cat, etc.
  12. Set your alarm clock for when you need to get up and then turn it to face the wall so you cannot see what time it is (if the alarm rings it is time to get up, otherwise it isn't).
  13. Lie down in bed and get comfortable.
  14. Become aware of your breathing. Slow it down a little. Make breathing in the same length as breathing out. You may become aware of your heartbeat.
  15. You may think about something pleasant and quiet, such as lying on a beach, etc.
  16. You may try some relaxation exercises (listed below).
  17. If you are not sleeping after a reasonable time, or if your brain starts to become "active", get up and leave the bedroom.
  18. Review the Worry List. You can read something short, relax, try warm milk or herbal tea, etc. When you feel tired go back to bed and repeat the process (step 10 - 14).
  19. Do not worry about sleeping poorly and getting up and down. This will happen at first. You will be more tired the next day and it will be easier to fall asleep the next night.
  20. The point is to associate going to bed with falling asleep, not laying awake worrying about not sleeping.

Basic Relaxation Techniques

Exercise 1

Regular breathing - let yourself relax - you may become aware of your heartbeat. That is normal and okay.

  1. As you inhale tighten up the muscles in your toes.
  2. As you exhale relax those muscles - let them become heavy and sink into the bed.
  3. Slowly work your way up your ankle, calf and upper leg.
  4. Then start in your fingers and work your way up your arms.
  5. Work your way up your trunk to your neck, head and face muscles.
  6. Just let yourself drift, feeling relaxed, limp and heavy on the bed.

Exercise 2

  1. Get into a comfortable position in the bed.
  2. Breathe in through your nose and out through your mouth using your belly muscles. The length of breathing in should be the same as breathing out.
  3. Picture a flat pebble falling into a still pool of water.
  4. The pebble rocks back and forth (like a leaf falling in the air) as it settles into the pond. Light darkens as the pebble goes deeper.
  5. Count down with your breathing starting with a breath in at 40. The mental image is the pebble rocking to one side.
  6. As you exhale the pebble rocks back to the middle.
  7. The next breath the pebble has shifted to the other side, and so on.
  8. If you lose track of counting, just pick a number and keep going down.
  9. People often fall to sleep part way through counting down. If you do not fall asleep but you are relaxed and resting this is restorative like simple meditation.

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American Academy of Sleep Medicine