Sleeping Without a Pill: Nonpharmacologic Treatments for Insomnia

Insomnia is a complaint of patients seen in many medical settings, but it is particularly prevalent in patients who present to mental health practitioners. When choosing an intervention for insomnia, physicians often turn to pharmacological management options as their primary strategy, with other modalities only considered secondarily, if at all. Medications for insomnia, which include benzodiazepines, nonbenzodiazepines, and antihistamines, have been found to have both varying degrees of efficacy as well as side-effect profiles that may limit their use. In recent years, the American Academy of Sleep Medicine has studied nonpharmacologic interventions for insomnia and found evidence to support their use in achieving sustained improvements in sleep parameters over time. Methods such as cognitive-behavioral therapy, stimulus-control therapy, relaxation, paradoxical intention, and sleep restriction are efficacious treatments that mental health practitioners can consider in the treatment of insomnia. Researchers are only beginning to review evidence concerning complementary and alternative medicine therapies (CAM); however, given the preponderance of patients who may be employing these techniques for insomnia, it is important that clinicians be familiar with these approaches, which merit further study. This article reviews nonpharmacologic treatments for insomnia that are available to mental health practitioners as well as primary care providers, either via direct application of the techniques or by referral. The evidence for each of these modalities is presented in an effort to expand the treating physician's armamentarium beyond sole use of the medications traditionally used to treat insomnia. (Journal of Psychiatric Practice 2008;14:403-407)