Psychological techniques that can help with sleep problems include cognitive behavioral therapy, relaxation training, meditation, and hypnosis. These techniques rely on a common set of skills:
- Deep muscle relaxation
- Focus elsewhere rather than on the pain
- Visual, sound, or other relaxing sensory imagery
- Distancing oneself from the chronic pain
Similar techniques are also used by people who want to manage stress and/or chronic pain during the day.
Cognitive Behavioral Therapy Eliminates Negative Thoughts
Cognitive behavioral therapy for insomnia focuses on controlling or eliminating negative thoughts, worries, and behaviors, and replacing them with more positive thoughts and behaviors so the individual can fall asleep.
Sessions typically include several weekly visits with a therapist, but this therapy is also available online.10 The medical literature has shown cognitive behavioral therapy effective in treating insomnia.11
When coupled with the deep breathing technique that follows, these techniques can be beneficial in improving sleep and decreasing the perception of pain by retraining the brain. Many of these skills are coupled with exercise in techniques such as yoga and tai chi.
In This Article:
- Chronic Pain and Insomnia: Breaking the Cycle
- Addressing Pain and Medical Problems Disrupting Sleep
- Practicing Good Sleep Hygiene
- Psychological Approaches for Insomnia
- Insomnia and Back Pain Video
Deep Breathing Exercises Make Sleep Easier
Most psychological techniques begin with controlled deep breathing. Although there are many relaxation exercises, the following is a simple example of a deep breathing technique that can help people fall asleep:
- Lie down in a comfortable position on the back with legs straight and slightly apart. Allow the toes to point comfortably outward and let the arms rest at the sides without touching the body. Place the palms up and close the eyes.
- Focus on breathing. The hand can be placed on the spot that seems to rise and fall the most as one inhales and exhales. Notice the position of the hand. Is it on the chest, abdomen or somewhere in-between?
- Now, gently place both hands on the abdomen and again focus on breathing. Pay attention to how the abdomen rises during inhalation and falls during exhalation. Try to make the hands rise and fall.
- Breathe through the nose during this exercise. If needed, one may clear the nasal passages prior to doing breathing exercises.
- If breathing into the abdomen is difficult, press the hand down on the abdomen during exhalation and allow the abdomen to push the hand back up during deep inhalation. The hand pressure will help create awareness of the action of the abdomen during breathing.
- Notice if the chest is moving in harmony with the abdomen, or if it appears rigid. Take a few minutes and let the chest follow the movement of the abdomen. This is done by continuing to focus on the abdomen moving up and down as one breathes and simply allowing the chest to follow its motion naturally.
If the above exercises are difficult, an alternative exercise is an option:
- Lie on the stomach with the head rested on folded hands. Take deep abdominal breaths so the abdomen can be felt pushing against the floor during breathing.
- As abdominal breathing is practiced for five or 10 minutes, check the body for tension.
If a person encounters difficulty with these breathing exercises or any of the other techniques, the doctor or therapist should be consulted.
- Ye YY, Zhang YF, Chen J, et al. Internet-Based Cognitive Behavioral Therapy for Insomnia (ICBT-i) Improves Comorbid Anxiety and Depression-A Meta-Analysis of Randomized Controlled Trials. PLoS ONE. 2015;10(11):e0142258.
- Mitchel MD, Gehrman P, Perlis M, and Umscheid CA (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: A systematic review. BMC Family Practice, 13, 40.