General measures
- Keep a regular daily routine.
- Exercise regularly during the day.
- Take a nap during the day (synonyms: siesta; power napping; napping; dozing; napping) – Taking a controlled 30-minute nap by setting an alarm before 3 p.m. – at least three times a week – reduces the risk by 37% of dying from coronary heart disease (CHD) and its consequences (e.g., myocardial infarction/heart attack). The same is probably true for apoplexy (stroke). Furthermore, napping has a beneficial effect on long-term blood pressure values: hypertensive patients who took a controlled 30-minute nap had a 5% (6 mmHg) lower mean 24-hour blood pressure value than the control group; the mean systolic blood pressure value was 4% (5 mmHg) lower during the day and as much as 6% (7 mmHg) lower at night. Note: However, in case of sleep disorders, naps should not be taken during the day!
- Create a buffer zone between the working day and going to bed.
- Evening:
- In the evening, dim the brightness (dim the lights) so that the brain knows the night is about to begin.
- In the evening especially note that TV and computer screens with their blue-heavy spectrum suppress the fatigue hormone melatonin.
- Half an hour before bedtime try to relax, for example, with a warm bath (34-36 ° C). There can also be relaxation-promoting additives in the bath water such as lemon balm, valerian and hops.
- The most important sleep rules:
- Never go to bed if you are not tired.
- The bed should only be used for sleeping or sex.
- Turn over the alarm clock! Looking at the clock at night promotes thinking about the hours that remain.
- Do not sleep too long and not too short (sleep stint between 6.5 and 7.5 hours).
- Get up at the same time in the morning regardless of sleep duration.
- Observe sleep hygiene (see “Regular rest and sleep (sleep hygiene)”).
- To get going quickly in the morning, let the daylight come into the room, so that the brain knows that the day begins (daylight sets the internal clock).
- Nicotine restriction (refrain from tobacco use) – After 19.00 should not be smoked due to the stimulating effect of nicotine.
- Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day) – From 18.00 o’clock to abstain from alcohol; alcohol promotes on the one hand to fall asleep, but on the other hand also the occurrence of sleep disorders.
- Limited caffeine consumption (max. 240 mg of caffeine per day; this corresponds to 2 to 3 cups of coffee or 4 to 6 cups of green / black tea) – no caffeinated beverages after lunch or 4 to 8 hours before bedtime should be abstained from caffeinated beverages. Note: Also consider sources of caffeine such as chocolate and cocoa.
- Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program – is also related to sleep apnea.
- BMI ≥ 25 → participation in a medically supervised weight loss program.
- Review of permanent medication due topossible effect on the existing disease (eg, abandonment of appetite suppressants). Some drugs such as painkillers contain a not insignificant amount of caffeine. Consequently, the package insert should be read carefully to see if the drug can cause sleep disorders.
- Avoidance of psychosocial stress:
- Trouble
- Unsolved problems
- Marriage crises
- Stressful situations
- Revision
- Performance pressure
- Stress
- Avoidance of environmental stress:
- Physical causes – altitude-induced sleep disturbance, noise, bright light, etc.
- Residential and environmental toxins – particle board, paint, wood preservatives, wall paint, flooring, etc.
Nutritional medicine
- Nutritional counseling based on nutritional analysis
- Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
- Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
- Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
- High-fiber diet (whole grains, vegetables).
- Observance of the following special dietary recommendations:
- Do not drink large quantities after 20.00, preferring to drink enough fluids throughout the day. So you avoid that the restful night sleep is interrupted by toilet trips.
- Avoid eating or drinking at night
- Heartburn or gastroesophageal reflux disease can be the cause of sleep disturbance. Omit spicy and fatty foods to avoid heartburn and indigestion.
- Sleep-promoting effect hot milk with honey and valerian, hops, chamomile and lemon balm tea. Milk contains the essential amino acid tryptophan, which promotes sleep.
- Diet rich in:
- Vitamins (vitamin B12)
- Minerals (magnesium)
- Secondary plant substances (eg genistein, daidzein, glycitein) – especially in menopausal women (menopause) who suffer from sleep onset and sleep disorders.
- essential amino acid L-tryptophan – Prefer:
- Cereals – crispbread, rye, wheat flour type 1050, barley, wheat, buckwheat, spelt flour, millet, oatmeal, edible bran.
- Legumes – peas, chickpeas, beans, dried lentils, lima beans, dried soybeans.
- Seeds and nuts – almonds, walnuts, hazelnuts, cashews.
- Egg and dairy products – cottage cheese 40% F. i. Tr., lean cottage cheese, Chester 50% F. i. Tr., Brie 50% F. i. Tr., Edam 40% F. i. Tr.
- Meat, poultry and sausages – frankfurter sausages, salami, goose, rabbit, smoked pork, beef fillet, chicken, boiled ham, pork fillet, pork liver.
- Fish – Baltic herring, redfish, carp, sardines in oil, cod, halibut, salmon, mackerel.
- Fats and oils – peanut paste
- Selection of appropriate food based on the nutritional analysis
- See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
- Detailed information on nutritional medicine you will receive from us.
Sports Medicine
- Endurance training (cardio training) and strength training (muscle training) – for therapy.
- Strenuous physical activities should be stopped four hours before bedtime!
- Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
- Detailed information on sports medicine you will receive from us.
Psychotherapy
- Stress management, if necessary
- It is also particularly helpful to learn relaxation techniques, such as the easy-to-learn “Progressive Muscle Relaxation according to Jacobsen”.
- Cognitive behavioral therapy (CBT); combination of: (American College of Physicians guideline: first-line agent).
- Psychoeducation (teaching the causes of insomnia).
- Behavioral therapy
- Stimulus control/reinforcement of the coupling between the sleep environment and sleep/relaxation; this involves the patient being instructed to use the bed only for sleep.
- Relaxation procedures
- Bedtime restriction (sleep deprivation, i.e., shortening bedtimes to eliminate unnecessary waking hours).
- Training (importance of sleep hygiene; for more information, see “Sleep hygiene”).
Note: For adults of any age, CT should be the first treatment option for insomnia.Cognitive-behavioral therapy training for insomnia (CBTi), sleep hygiene and restriction – effective for chronic and comorbid insomnia [Sk2 guideline].
- Meditation – Mindfulness meditation (Mindfulness Meditation) led to improvement in sleep quality and also had a significant positive effect on daytime sleepiness.
- Detailed information on psychosomatics (including stress management) can be obtained from us.
Complementary treatment methods
- Acupuncture
- Aromatherapy
- Light therapy (1,000-7,500 lx for 30-90 min) – may be recommended for the treatment of insomnia in neurodegenerative diseases [S2k guideline].
- Meditation
- Medical hypnosis (synonym: hypnotherapy)
- Music therapy
- Reflexology
- Yoga/Tai Chi/Chi Gong
