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The term "nonpharmacologic therapy" refers to treatments or interventions that are used to achieve a specific goal without the use of medications. Nonpharmacologic therapies for insomnia primarily involve a form of psychotherapy called cognitive-behavioral therapy. The primary objectives of cognitive-behavioral therapy for insomnia include:

• Modify and reverse poor sleep habits
• Better regulate sleep-wake schedules
• Correct faulty beliefs and attitudes about sleep
• Reduce the level of emotional and physiological arousal that many people with insomnia experience before going to sleep
• Help the patient develop adaptive coping skills to counteract insomnia

Cognitive-behavioral interventions can help improve sleep and decrease insomnia in about 70%-80% of patients. Cognitive-behavioral treatments for insomnia include:

• Sleep-hygiene education
• Sleep restriction therapy
• Stimulus control therapy
• Relaxation training
• Cognitive therapy

Sleep-Hygiene Education

Sleep-hygiene refers to the habits and practices of everyday life that affect sleep. Poor sleep habits and practices play a major role in insomnia and sleep-hygiene education teaches people to recognize and minimize these factors in order to improve sleep.

Sleep-hygiene education teaches and emphasizes the following sleep habits and practices:

• Go to bed only when you feel sleepy
• Don't eat a heavy meal before going to bed
• Try to maintain the same sleep/wake schedule 7-days a week
• Try to avoid napping during the day
• Avoid caffeine, alcohol, and other stimulants (particularly in the evening)
• Avoid exercise and other strenuous physical activity just before retiring to bed. These activities should be performed during the day or early in the evening
• Don't engage in strenuous mental activities just before going to bed
• Maintain a comfortable bedroom environment by minimizing excessive light, noise, and temperature
• Limit intake of liquids in the evening which can bring on the urge to urinate during the night
• Engage in relaxing and enjoyable activities before retiring to bed

Sleep Restriction Therapy

The goal of sleep restriction therapy is to restrict or limit the patient's time spent in bed to the amount of time actually spent sleeping. In other words, a person who suffers from insomnia should only be in bed when they are asleep. For example, if a person with insomnia spends a total of 9 hours in bed each night but only sleeps 6 hours, the goal of sleep restriction therapy is to limit the patient's time in bed to only 6 hours. If sleep initiation (i.e., falling asleep) is the major problem, the patient is advised to go to bed later than they usually do. Conversely, if early morning awakening is the main problem, the patient would be advised to get up earlier than usual. Because daytime drowsiness can be a major side effect of sleep restriction therapy, the initial time in bed is set at no less than 5 hours to avoid extreme sleep loss over time.

Prior to starting sleep restriction therapy, the therapist will ask the patient to keep a sleep log or diary for about a week to determine the sleep efficiency. The sleep efficiency is calculated as follows: (Total Sleep Time) divided by (Total Time in Bed) times 100. For example, if the results of your sleep log shows that over the course of a 7-day period you spent 63 hours in bed but only got 42 hours of actual sleep, your sleep efficiency would be (42/63) X 100 or 66%.