Treat Sleep Problems Without Medication

The psychologist explains why behavioral therapy helps better during waking nights than sleeping pills. Find out everything about the best possible therapy.

The updated treatment guidelines recommend behavioral therapy for sleeping disorders instead of sleeping pills. Why this turn?

When revising the old guidelines, we took the current study situation into account. Meanwhile, behavioral therapy is much more researched – and the data is better than sleeping pills. Especially the classic benzodiazepines, there are hardly any reasonable studies. Here is an international trend: Already last year, experts from the American College of Physicians have recommended cognitive behavioral therapy as the treatment of choice.

According to the “Health Report 2017”, almost twice as many workers today swallow sleep aids as in 2010. How does that work?


Although the report notes an increasing consumption of sleeping pills and sedatives, it does not say anything about the duration and cause of incomes. Benzodiazepines are not only prescribed for insomnia, but also for anxiety and inner restlessness. We did not want to demonize these drugs, but to weigh the current scientific data and at the moment I see the behavioral therapy clearly ahead.

Has one become more restrained with sleeping pills because of the addictiveness? Finally, according to the “Yearbook addiction” 1.5 million people are dependent on it.

To minimize the risk of dependency, we recommend taking sleeping pills only for a short time. For more than four weeks, they should not be prescribed. The active ingredients zopiclone and zolpidem have long been considered unproblematic. But here we have learned, because there are now many permanent users. However, the long-term therapy with sleeping pills has never been scientifically supported, which is why it is generally not recommended. In addition, patients with chronic sleep disorders have the same problems after weaning as before.

How can you help these people?

The goal must be to improve sleep without medication. Therefore, it would be useful to offer a comprehensive behavioral therapy to all those who are more affected – with relaxation methods, a structuring of the daily routine and techniques that reduce nocturnal pondering. At the moment this is not realizable.

Probably because there are not enough therapists.

I agree. The guideline is intended as an impetus to improve the supply situation as quickly as possible. However, not every patient needs the full package with a trained behavioral therapist. This should be reserved for severe chronic cases. And not everyone affected is ready to do a therapy. Alternatively, a simple sleep consultation with the family doctor or pharmacist could be helpful. These could easily set the course by lighting unfavorable habits and giving individual tips.

How does behavioral therapy help against nightly pondering?

As part of a cognitive behavioral therapy, those affected learn to question their negative expectations. Do I actually make catastrophic results after a bad night? And am I really awake as much as I think at night? If the sufferer realizes that they “work” despite their sleep disturbances, they lose the fear and get a more relaxed relationship. There’s no point in panicking after a bad night. Nevertheless, patients must feel taken seriously.

So some people are getting into their sleep problems?

This is indeed often the case. Objectively measured, sleep-disordered patients have about half an hour less sleep than normal sleepers, but subjectively experience two hours less sleep. Because of their altered brain waves, they have more short waking phases in the second range, so they are in a kind of permanent tension. Even in the deep sleep phase, parts of the brain are active, so that those affected experience their sleep as shorter and more superficial. But even in this case, the sleep system works, and the body gets the vital sleep when it needs it.

Who is the first contact for insomnia?

Since there are not enough sleep medicine centers, the family doctor should control the therapy. The Society for General and Family Medicine has created a guideline for family doctors. These exclude first physical illnesses and assess whether a sleep-hygienic counseling is sufficient or whether the patient needs an appointment in the sleep laboratory, a cognitive-behavioral therapy or a longer-term psychotherapy – for example, when the sleep disorders are accompanied by depression and anxiety disorders. Some patients also benefit from Internet-based treatment.

Are there any suitable online therapies?

In the English-speaking world there are now various interactive offers, in Germany there is so far only one project at the University of Lüneburg. They are currently planning to develop their own internet-based therapy with a personal consulting hotline.

What do so-called sleep trackers do, with which one analyzes one’s own sleep quality?

These lifestyle products are very popular at the moment but carry the risk of fixing oneself too much on sleep and thereby induce a sleep disorder. I find a sleeping diary much more useful because it helps people better assess their sleep quality. An objective measurement is only possible in the sleep laboratory.

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