Lifestyle modifications

INTRODUCTION

  • The Sleep is fragile and influenced by many factors. Identifying these factors is key to treating insomnia (1)
  • Insomnia is caused by a combination of predisposing, precipitating, and perpetuating factors that change over time. Each factor should be assessed to create a personalized treatment plan (1)

Cognitive behavioral therapy for insomnia

  • Behavioral components: A) Stable wake time and bedtime all days a week. B) Sleep restriction. C) Good sleep hygiene: Avoid daytime napping, limit/avoid caffeine, alcohol and nicotine particularly close to sleep, perform regular physical activity/exercise at least 4-6 hours before sleep, dark and quiet sleep environment, avoid large evening meals (1)

NUTRITION

  • Carbohydrates: High carbohydrate intake may increase REM sleep compared to low carbohydrate intake. Low carbohydrate intake may increase deep sleep (3)
  • Vitamin D deficiency is associated with increased risk of sleep disorders (4), and vitamin D supplementation may improve sleep quality (5)

PHYSICAL ACTIVITY

  • Regular physical exercise has moderate positive effect on sleep quality, a small to moderate positive effect on sleep onset latency, and a small positive effect on total sleep time and sleep efficiency (6)

SMOKING

  • Smoking within 4 hours before sleep is associated with incerased sleep fragmentation (2)

STRESS

  • Psychological stress is associated with reduced deep sleep, REM sleep and sleep efficiency, as well as an increase in awakenings (7)

References

1) https://www.uptodate.com/contents/overview-of-the-treatment-of-insomnia-in-adults

2) https://academic.oup.com/sleep/article/42/11/zsz136/5535848

3) https://www.mdpi.com/2072-6643/13/4/1283

4) https://www.mdpi.com/2072-6643/10/10/1395

5) https://www.mdpi.com/2072-6643/14/5/1076

6) https://link.springer.com/article/10.1007/s10865-015-9617-6

7) https://www.tandfonline.com/doi/abs/10.1080/15402000701557383

Resources

EXPLANATION TO EVIDENCE PRESENTATION

Figure: Evidence pyramid

​Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD font

​Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE font

​Evidence based on randomized controlled trials is written in PLAIN font

​Evidence based on observational / cohort studies is written in CURSIVE font