Non-specific treatments
Improving sleep hygiene
It should be provided to anyone with insomnia. It mainly consists in:
• Understanding that there is no rule for how much someone should sleep - older patients need less sleep.
• Keeping a regular sleep schedule – going to bed and getting up at the same time
• Avoiding long daytime naps (difficult for fatigued, seriously ill patients), alcohol, and caffeine.

Behavioral treatments
• Relaxation techniques just prior to bedtime - progressive muscle relaxation, guided imagery, meditation, or diaphragmatic breathing.
• Stimulus control focused on establishing a connection between the bed and sleep - not watching TV or reading in bed
• Sleep restriction - restricting the time allowed in bed.
• Cognitive behavioral therapy focused on identifying unwanted feelings or thoughts and replacing them with more positive thoughts.

Physical exercises - studies in elderly patients suggest significantly improved sleep duration and onset latency and minimal enhancement in sleep efficiency with low impact aerobics, brisk walking, etc.

It is not defined how long non-pharmacologic therapy should be tried before attempting other measures: this depends on the patient, the severity of the insomnia, or the severity of the illness - a treatment regimen of 7-8 weeks shows to be effective.

Specific treatments
Symptoms from a medical disorder can also contribute to insomnia - adequately treating a patient’s pain, nausea and vomiting, or dyspnea should improve sleep.
Spiritual and existential concerns can be an important cause of insomnia – It is important to address these concerns during the day because patients can avoid them during the day but not during the night. Brief psychotherapy may be helpful.

See reference for more information.

Adapted from Arnold R, Miller M & Metha R. Insomnia: non-pharmacologic treatments. Palliative Care Network of Wisconsin. Fast facts and concepts # 104. Internet. Available at https://www.mypcnow.org/fast-fact/insomnia-non-pharmacologic-treatments/ Accessed on May 6, 2018.