Non-drug Therapy
Patients still symptomatic after sleep hygiene education should be considered for additional interventions. Although how long cognitive behavioral techniques should be tried before prescribing medications is unclear, some attempt at most of these interventions is reasonable and safer than drugs, and may be sufficient, alone or in combination, to
avoid long-term hypnotic use.5 Some of these approaches amplify principles of sleep hygiene education through more detailed and formalized training and assessment. Implemen- tation may take some time (several weeks or more) and require special training for the provider or referral to a sleep therapy specialist.6
Cognitive behavior therapy can produce significant, last- ing improvement in all measures of insomnia and may be an effective alternative to drugs in chronic users.1,4,7 Relax- ation therapy reduces physical and mental stress just before bedtime through progressive muscle relaxation (systemati- cally tensing and relaxing all major muscle groups), medi- tation, and guided imagery (imagining peaceful venues and listening to calming sounds). Stimulus control removes all