Nonpharmacologic Strategies in the Management of Insomnia: Rationale and Implementation

Sleep is often perceived as capricious and vulnerable to self-sabotage by individuals contending with chronic insomnia. Nonpharmacologic strategies for insomnia counter this elusiveness by plotting an indirect course toward improvement. In contrast to sleeping pills, which directly increase the propensity to sleep on a neurophysiologic basis, nonpharmacologic treatments align a wide array of physiologic, cognitive, behavioral, environmental, and social factors toward the goal of achieving better sleep. Although they do not share the face validity of sleeping pills, nonpharmacologic strategies for insomnia can be just as effective, especially when accompanied by a clear rationale. Furthermore, they promote a sense of self-efficacy in patients who may feel that they have lost or ceded control of their ability to sleep.