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Non-pharmacological management of insomnia

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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non pharmacological treatment of insomnia

Cognitive behavioural therapy for insomnia (CBT-I) is the first line treatment in chronic insomnia.

  • can be delivered either individually or in small group format
  • has been found to be as effective as prescription medications for short-term treatment of chronic insomnia

This psychological intervention addresses the various cognitive and behavioural aspects with the use of following interventions:

  • behavioural strategies
    • sleep restriction
      • can be used in primary care and is useful for people who spend a lot of time in bed but not sleeping.
      • main aim is to reduce the time spent in bed to closely match actual time spent asleep
        • strict bedtime and rising schedule should be followed which is calculated according to the average expected hours of sleep
        • wake time should be fixed (regardless of actual sleep duration)
      • if patient is still not sleeping better
        • reduce the time in bed by 30 min
        • continue for at least two weeks before making another change
        • time in bed usually should not be reduced to less than 5 hours or the average expected hours of sleep
      • if patient is sleeping better but feels sleep deprived
        • add 30 minutes to the time in bed every week and continue till the the feeling of sleep deprivation disappear

    • stimulus control therapy
      • main aim is to reassociate the bed and bedroom with sleep and create a constant sleep-wake routine
        • go to bed only when sleepy
        • use the bedroom only for sleep and sex
        • read or engage in other quiet activities and return to bed only when sleepy
          • if unable to sleep after 15 to 20 minutes in bed, get out of the bed and return only when sleepy ( repeat as necessary)
        • avoid naps
        • wake up at the same time each day

    • relaxation
      • can use variety of techniques e.g. - breathing, focused relaxation, visual imagery, and meditation
      • carry out daily, engage in short relaxation periods (2-3 minutes) several times during the day

  • education - about sleep hygiene
    • stress on the importance of environmental and physiological factors, behaviours, and habits to promote sound sleep
    • following principles in basic sleep hygiene can be provided to the patient
      • limit use of caffeine to 1 cup of coffee in the morning (if at all), avoid alcohol and cigarettes at night, and limit other substances that can affect sleep
      • go to bed when drowsy and feeling sleepy
      • daytime naps should be avoided
      • regular exercise (avoid exercise late in the evening)
      • avoid computer screens hours before bed and also watching the bedroom clock
      • bedtime environment should be conducive to sleep e.g. - bed should be comfortable, the temperature not too hot or cold, the room dark, and noise minimised

  • cognitive strategies - cognitive therapy
    • targets on changing false beliefs and attitudes about sleep which may result in anxiety and distress (e.g., everyone needs at least 8 hours of sleep for good health (1,2,3,4)


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