Therapy	Techniques
Sleep hygiene	Exercise regularly (not within 4 hours of bedtime)
	Avoid large meals and limit fluid intake in the evenings
	Limit caffeine, tobacco, and alcohol intake
	Use the bedroom for sleep and sex only
	Maintain a regular sleep-wake cycle without daytime napping
	Avoid distracting stimuli at bedtime, such as loud noises, bright lights when not being used therapeutically, and extreme temperature variations
Stimulus control	Lie down to sleep only when feeling sleepy
	Use the bedroom for sleep and sex only
	Avoid wakeful activities at bedtime (e.g., watching television, talking on the phone, eating)
	Leave the bed if unable to fall asleep within 20 minutes and return when sleepy
	Maintain a consistent sleep-wake cycle (e.g., set the alarm for the same time each morning regardless of how much sleep occurs during the night)
Sleep restriction	Limit time in bed to the number of hours actually spent sleeping (not less than five hours); sleep time gradually increases as sleep efficiency improves
Paradoxical intention	Advise patient to remain awake to help alleviate the anxiety associated with the pressure to fall asleep
Relaxation training	Autogenic training: imagine a calm environment with comforting body perceptions such as warmth and heaviness of the limbs
	Imagery training: focus on pleasant images
	Hypnosis, meditation, yoga, abdominal breathing, progressive muscle relaxation (from the feet up to the facial muscles)
	Visual or auditory biofeedback therapy: teaches the patient to control specific physiologic factors, such as muscle tension
Cognitive therapy	Counseling
	Identify and replace dysfunctional beliefs regarding sleep (e.g., overestimation and apprehension about the number of hours needed for sleep)
	Use of a journal to write down thoughts
Cognitive behavior therapy for insomnia	Combination of cognitive therapy, stimulus control, and sleep restriction therapy with or without relaxation therapy
Multicomponent therapy	Combination of stimulus control, relaxation therapy, and/or sleep hygiene education
Temporal control therapy	Focus is to restore sleep-wake cycle; patient instructed to wake up at the same time every day, regardless of total amount of sleep, and to avoid daytime naps