There are many ways to treat some sleep disorders without using medications. The practice of these methods is called “behavioral sleep medicine” or “BSM.” Doctors who are certified BSM specialists have an expertise in the use of these treatment methods.
The following list presents a summary of the most common behavioral treatments for sleep disorders.
Insomnia
Insomnia occurs when a person has trouble falling asleep or staying asleep, wakes up too early, or feels unrefreshed after sleeping.
- Biofeedback
You use images or sounds as cues to help you control muscle tension or mental activity.
- Multicomponent therapy
This is a combination of more than one behavioral treatment for insomnia.
- Paradoxical intention
You focus on trying to stay awake instead of trying too hard to fall asleep.
- Relaxation training
This helps you manage tension and anxiety that may prevent you from sleeping.
- Sleep hygiene education
You learn to develop habits that help you sleep better. This is often combined with other behavioral methods.
- Sleep restriction
You restrict your time in bed to the actual amount of time you normally spend asleep. As your sleep improves you then gradually extend this time in bed.
- Stimulus control
This method teaches you to use the bed only for sleeping. You also learn to control the time you spend in bed.
Obstructive Sleep Apnea (OSA)
OSA is a sleep related breathing disorder. As you sleep tissue in the back of the throat collapses and blocks the airway. This causes you to stop breathing up to hundreds of times per night.
- CPAP desensitization
This helps you gradually adjust to using continuous positive airway pressure (CPAP) therapy.
- Positional therapy
This method prevents you from sleeping on your back. It helps keep your airway open as you sleep. It tends to work best for younger people who are less obese and who have less severe OSA.
- Weight reduction
Dietary weight loss may reduce OSA in obese people. But this method is rarely the sole solution for OSA. It should be combined with CPAP, an oral appliance or surgery.
Circadian rhythm sleep disorders
These disorders involve a problem in the timing of when a person sleeps and is awake. This timing is regulated by your internal body clock.
- Bright light therapy
This helps you reset the timing of your internal body clock. It exposes your eyes to intense but safe amounts of light for a specific and regular length of time.
Behavioral insomnia of childhood
This involves behaviors and habits that keep a child from falling asleep or staying asleep.
- Unmodified extinction
After putting your child to bed you ignore his or her cries until morning.
- Extinction with parental presence
You remain in your child’s room but ignore his or her cries until morning.
- Graduated extinction
You ignore a crying child for a set period of time. Then you briefly return to check on the child and repeat the process.
- Delayed bedtime with removal from bed
You wait to put your child to bed until the time of night when he or she typically falls asleep. If the child is unable to fall asleep you briefly remove him or her from bed.
- Parent education and prevention
You learn how to help your child develop positive sleep habits.
- Positive bedtime routines
You develop a regular routine of quiet activities to get your child ready for bed each night.
Bedwetting
This parasomnia occurs when a person urinates by accident in his or her sleep. Most children should be able to control their bladders during sleep by the time they are about five years of age.
- Alarm therapy
A moisture-sensitive pad is placed under the child. An alarm sounds when the pad becomes wet.
- Fluid restriction
You reduce the amount of fluids that your child drinks in the later afternoon and early evening.
- Positive reinforcement
You motivate your child by giving rewards for keeping the bed dry.
- Scheduled awakenings
You wake your child at certain times of night so he or she can go to the bathroom.
This method is also useful for treating other childhood sleep disorders. You can use it for a child who often wakes up during the night. It also may help a child who has frequent episodes of a parasomnia such as sleepwalking. Keep track of the time of night when these events occur. Then briefly wake your child 15 to 30 minutes before the usual time.
More Information
Behavioral Sleep Medicine: Improving Sleep without Pills
Cognitive Behavioral Therapy for Insomnia
Certified Behavioral Sleep Medicine Specialists
Reviewed by Nilesh Davé, MD
Updated August 13, 2007
