Muscle relaxation, breathing exercises, guided imagery, and stories to combat insomnia

As many know, cognitive behavioral therapy (CBT-I) is the gold standard and most effective manner to treat insomnia in the long run. Within its rubric are muscle relaxation, breathing exercises, guided imagery, and stories that can facilitate sleep. 

With muscle relaxation, you’ll focus on the different parts of your body and how they relate to it. Tighten your muscles one at a time, and then relax them. Tighten your abdominal muscles and then relax them. Close your eyes forcefully and then open them. Curl your toes and then straighten them. The goal is to focus on the present and the control that you have over your body. It is control that can apply to your other endeavors. Realize that you oversee your body, your sleep, and your life.

Similarly, breathing exercises help you to stay in the moment. Before sleep (during your uninterrupted cushioned time before going to bed) find a quiet environment, whether this be the bath or a small space in your living room—but not the bedroom environment—and practice deep breathing. Deeply, and slowly, breathe in and out. You may also want to utilize the 4-7-8 breathing pattern, also known as the relaxing breath, which involves breathing in for 4 seconds, holding the breath for 7 seconds, and exhaling for 8 seconds. The breathing pattern is based on pranayama, which is an aspect of yoga that pertains to the control of breathing. Not only does this technique help you to diminish anxiety and control responses such as anger, but it also decreases heart rate. Initially, only 4 breath cycles in a row should be attempted, as this technique can cause lightheadedness. However, over time, once an individual is acclimated to the technique, the results can be overpowering. This breathing technique can not only be utilized for insomnia but for other stressful situations, as well. Our relaxation response is mediated by the vagus nerve, and one way to engage this nerve is to conduct this deep breathing exercise. Dr. Andrew Weil, an integrative medicine specialist at The University of Arizona, has even called the relaxing breath a “natural tranquilizer for the nervous system”; it increases heart rate variability, which is a good thing. When we inhale, our heart rate increases and when we exhale, the heart rate decreases. Heart rate variability is beneficial because the greater it is, the greater the efficacy of the heart to pump blood to our various organs and muscles.

Another relaxation technique that is highly useful and can serve as another tool in our armamentarium against insomnia is guided imagery. Guided imagery allows you to recreate a setting in which you may have felt your best, whether this be an event, a relaxing locale, or anywhere else, and imagine yourself there again. Alternatively, you can imagine a setting in which you have never been but have always imagined as a tranquil spot, your own private Shangri-La, whether this be an isolated island with no intrusion from anyone or anything, a favorite spot with your loved one(s), or up in space. It really doesn’t matter, so long as it’s personal to you. Think of it as a teleportation, one where you, alone, are in control of your destiny. In this scenario, you should immerse yourself in all the senses—visual, olfactory, aural, gustatory—and practice a sort of mindfulness. Imagine how you would interact with the flora and fauna in your imagined space, how you would act toward this environment, and how you would conduct yourself. Not only will the halcyon scene relax you, but it will introduce a distraction from your insomnia. When insomnia occurs, you should detach yourself from anything related to the bed or bedroom environment by either physically leaving it or mentally teleporting yourself elsewhere.

Some of my patients have found it useful to be lulled into sleep, like a baby. Meditative stories, either via podcasts or apps like HeadSpace, allow another avenue in which to feel relaxed and less anxious. The soothing and often soporific voices these narrators use is in direct contrast to the bustling noise of the workday. The result is a hypnotic trance that may allow you to sleep quicker. Heart rate and breathing will slow, which increases the chances of falling and staying asleep faster.

If you usually read in bed, don’t be afraid to continue this habit. Light reading can help you quickly fall asleep, especially if it’s fiction. Studies have shown that fiction allows you to escape the realities of the present day to a remote place, where you are implicated in someone’s else predicament, not your own. Not only does this allow for empathy, but it also helps you forget about your problems. When the brain is occupied, the body’s fatigue takes over and allows sleep to occur naturally. Reading until one is so tired that they cannot focus on the words is a good strategy.

Again, these techniques can be used not only for insomnia but for any situation in which you find yourself stressed. Remember: sleep is an extension of your life. What affects your daily, active life will also affect your slumber. Take this to heart and allow yourself to exercise some of these techniques we’ve learned that are also applicable to your day-to-day activities.