[3] Therapy of bedtime and sleeping time restriction:
The aim of this therapy is to consolidate sleep through
restricting the time that patients spend in bed to the average
time they spend sleeping (i.e. the number of hours
that they really spend sleeping), based on the information
in the sleep diary. This technique creates a mild state of
sleep deprivation that may cause daytime somnolence.
However, at the same time, it provides sleep consolidation,
thus making it easier to fall asleep, improving sleep
efficiency and decreasing latency and variability between
nights. It is not recommended to have less than four to
five hours of sleep, and the necessary adjustments must
be made in relation to time spent in bed, according to patients’
responses to the proposed treatment. If patients
reach 90% sleep efficiency, 15 minutes are added to the
time allowed in bed and, if the efficiency is less than 85%,
15 minutes are taken away.
[4] Relaxation techniques: The aim of teaching relaxation
techniques is to show patients how tense and hypervigilant
they are during both day and night. Progressive
relaxation is the treatment for insomnia that has been
studied most. Patients are guided to tension and relax
the major muscle groups sequentially, while observing the
sensation of tension and relaxation.
[5] Cognitive restructuring: This is mainly based on
cognitive symptoms that can cause or perpetuate insomnia.
Cognitive restructuring works on concerns, thoughts,
false attitudes, irrational beliefs about sleep and amplification
of its consequences, false ideas about the causes
of insomnia and disbelief about sleep induction practices
and about their own capacity to sleep. The idea is to
make patients abandon the symptoms of insomnia, by reminding
them that the way in which events are thought
about or judged determines the way that individuals feel
about them.
[6] Paradoxical intention: This technique reduces the
anticipatory anxiety associated with the fear of trying
to fall sleep and not being capable of doing so, since insomniacs
usually believe that they have lost their natural
capacity to fall asleep. Patients are instructed to go to
bed and stay awake and try not to sleep; this makes them
more relaxed and not under obligation to fall asleep. They
consequently fall asleep faster