Insomnia

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