Treatment Options

Non- Pharmacological

Although behavioural and psychological factors have been shown to play an important causative role in many sleep disorders, non-pharmacological/behavioural approaches are underused in the management of these conditions.^1,2 This underuse may be because only some of these approaches have been adequately evaluated in clinical studies,³ or because few physicians are trained in the use of non-pharmacological therapies.¹

However, many non-pharmacological methods have been used to treat sleep disorders and, as well as being used individually, behavioural techniques can be applied as a combination referred to as cognitive– behavioural therapy (CBT). Regardless of the original cause of the sleep disorder, behavioural and cognitive factors are nearly always involved in perpetuating the sleep problems and, as shown in Figure 1, can lead to a vicious circle of events. CBT aims to target these perpetuating factors, and thereby break the cycle.

Some of the most frequently encountered non-pharmacological techniques are:

relaxation techniques
biofeedback
stimulus-control therapy
sleep restriction therapy
sleep hygiene education
cognitive therapy.

Alternative therapies are also discussed.

References:
1.National Institute of Health. NIH State of the Science Conference statement on manifestations and management of chronic insomnia in adults statement. J Clin Sleep Med 2005; 1 (4): 412–421.
2. Subramanian S, Surani S. Sleep disorders in the elderly. Geriatrics 2007; 62 (12): 10–32.
3. Szuba MP, Kloss JD, Dinges DF (Eds). Insomnia. Principles and management.^© Cambridge University Press, 2003.