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Health Protocols


Non-pharmacological Therapies

Improving Sleep Hygiene

One of the most widely used behavioral therapies is improving "sleep hygiene." There is a correlation between good sleep hygiene and reduced daytime sleepiness (Mastin 2006; Yang 2010). Sleep hygiene encompasses a number of behaviors and environmental factors that contribute to good quality sleep (Yang 2010; Lande 2010). Consider the following sleep hygiene measures:

  • Minimize the amount of light, noise and changes in temperature in the bedroom.
  • Avoid eating large meals before bed. Indigestion can make falling asleep difficult.
  • Limit the amount of stimulants (e.g., caffeine, nicotine, and alcohol) consumed during the day, especially close to bedtime.
  • Avoid vigorous exercise during the two hours prior to sleep.
  • Avoid bedtime activities not related to sleep (e.g., watching TV, reading, or listening to the radio).
  • If worrying about falling asleep and the time, cover the alarm clock to avoid anxiety.

Sleep Restriction to Reset Circadian Rhythms

Sleep restriction therapy limits the amount of time spent in bed (including naps) to increase the biological need for sleep at night. A study comparing sleep hygiene therapy plus sleep restriction to sleep hygiene therapy alone found that sleep restriction improved "sleep efficiency," a measure of the proportion of time spent in bed that resulted in sleep (Hoch 2001; McCurry 2007). This process usually begins by restricting the time spent in bed to the amount of time estimated one should spend sleeping. For example, a person who stays in bed for nine hours but only sleeps six will initially restrict time in bed to six hours. This causes mild sleep deprivation in the beginning. However, the sleepiness it creates trains the body to fall asleep more quickly. As the body adjusts, people can extend the amount of time spent in bed by 15 to 20 minutes until they are able to get a full night sleep without spending extra time in bed (McCurry 2007).

Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) for treatment of chronic insomnia helps people develop behaviors that are more conducive to sleep. It has been shown to be an effective treatment for both “primary insomnia” (insomnia not due to other diseases) (Edinger 2001; Smith 2003) and insomnia caused by other medical problems (Savard 2005; Smith 2005). Notably, CBT for treatment of chronic primary insomnia may be more effective than the medication zopiclone in older adults (Sivertsen 2006).

General Lifestyle Considerations

General lifestyle considerations that may benefit people with insomnia include (Lande 2010):

  • Getting regular exercise
  • Developing a sleep ritual aimed at improving relaxation and resolving emotional dilemmas before going to bed. Resolving stress may help improve sleep quality. People with insomnia should also review the Stress Management protocol.