By Michael Breus, PhD, ABSM
Insomnia is a widespread sleep problem among adults. Nearly 40% of men and women in the U.S. experience some symptoms of insomnia in a given year, and as many as 15% of adults struggle with chronic insomnia. Relaxation techniques are considered a standard form treatment for insomnia by sleep professionals, and the American Academy of Sleep Medicine. These techniques include:
- Muscle relaxation exercises
- Deep breathing exercises
- Imagery and visualization
These effective therapeutic practices are inexpensive, drug free, easy to learn and integrate into a daily routine, and can be very effective in improving sleep. Non-pharmaceutical sleep remedies are attractive to many people who don’t want to use medication to treat their insomnia and other sleep problems. This often leads people to seek other options in an area known as Complementary and Alternative Medicine (CAM). CAM is defined by the National Institutes of Health as “a group of health care systems, practices, and products that are not generally considered part of conventional medicine.” The NIH estimates that as many as 38% of adults in the United States use some form of CAM, most often in conjunction with conventional medicine, rather than in place of it.
Despite its popularity, we don’t know a great deal about how people use relaxation techniques and CAM, including what health problems they’re being employed to treat. Researchers at Harvard Medical School and Johns Hopkins University School of Medicine sought to remedy this by conducting this study to assess how people with insomnia use relaxation techniques and CAM to treat their sleep disorder. They found that while many adults with insomnia are using these therapies, only a small percentage of them are using them specifically to treat insomnia.
Researchers used data from the National Health Interview Survey, a large-scale, in-person survey on a wide range of health issues conducted by the Census Bureau and the Centers for Disease Control. The final study group included 23,358 adults.
Researchers in the current study investigated the prevalence of relaxation techniques, including deep breathing, muscle relaxation, biofeedback and guided imagery. They also examined the use of CAM, which they separated into four broad categories:
- Alternative and mind-body medicine: including meditation, yoga, Tai chi
- Manipulative practices: including massage, chiropractic and osteopathic treatments
- Other CAM practices: including acupuncture, Ayurvedic medicine, homeopathy, naturopathy
- Natural products: including non-vitamin and non-mineral supplements, particularly those used for insomnia treatment, such as melatonin and valerian
Researchers collected information about reasons for using relaxation and CAM, and whether people used these therapies specifically for insomnia. Finally, they asked whether people who used these treatments had informed their physicians about their use. They found that use of both relaxation and CAM techniques are common among people with insomnia—more common than in people without insomnia. However, the vast majority of people with insomnia who use these therapies are not using them specifically to treat their insomnia. Here are some of the details:
- 18% of those included in the study had regular insomnia or difficulty sleeping in the past year. More women than men suffered from insomnia, as did older people, and those with lower education and income levels.
- Of those people with insomnia, 22.9% used some type of relaxation therapy in the past year, compared to 11.2% of people without insomnia. Deep breathing exercises were the most common type of relaxation therapy used.
- Fewer than one-fifth—only 19.1%–of people discussed their use of relaxation therapy with their primary physician.
- 29.9% of those with insomnia reported using relaxation exercises for specific medical issues, but only a very small number—30 individuals in total—reported using relaxation techniques to treat their insomnia. This was too small a figure for researchers to calculate a population-based estimate.
- When it came to CAM, 45% of adults with insomnia used some form of complementary or alternative medicine in the past year, compared to 30.9% of those without insomnia.
- Natural products were the most commonly used of the four categories, followed by manipulative practices. However, researchers found that use of natural products specifically for insomnia was very low.
- 54% of adults with insomnia used some form of CAM for specific health problems, but only 1.8% reported using CAM to treat insomnia.
- In the case of both relaxation techniques and CAM, women were more likely than men to use these therapies, as were people with higher levels of education and income, and people who reported higher levels of physical activity.
There seems to be a real missed opportunity here, to improve insomnia by applying therapeutic techniques that people with this sleep disorder are already using. These broad categories of relaxation and CAM cover a wide range of treatment options. Not all of these techniques will be right for everyone. And further research is needed to fully evaluate the effectiveness of specific therapies. But there exist a number of relaxation and CAM therapies, including meditation and visualization, yoga and acupuncture, that have shown promising results in helping alleviate insomnia and other sleep problems.
Talking with your doctor is an important step in making the most of relaxation techniques and complementary or alternative therapies to improve insomnia. It’s disappointing to see that most people who are using these remedies are not discussing them with their physicians, according to this current research. Increasingly, conventional medical practitioners are open to, informed about and encouraging of techniques such as these. Don’t go it alone. Your “regular” doctor can be a valuable resource in making choices about “alternative” therapies for insomnia and other sleep problems.
Michael J. Breus, PhD
The Sleep Doctor™