in pictures and a few words
What this is and why
Five ways to sleep better without pills. Each was tested in people, and each can be started today.
- Sleep therapy, music, a warm bath, movement, meditation
- Sleep therapy is advised as the first step
- They can be combined — one step a week
Sleep therapy
Not talking about problems, but a set of rules: bed only for sleep, getting up at the same time, less time in bed awake, a calm answer to the thought “I won’t fall asleep again”.
- You fall asleep noticeably faster
- Night-time awakenings are shorter
- The improvement seems to last
Tested in people. Tested in people: adults with long-standing insomnia slept more soundly, with no harm.
Music before bed
Calm music every evening for 25–60 minutes. The effect builds up over a course — from a few days to a few months.
- Without lyrics, or familiar slow tunes
- Quietly, lying down or before bed
- Sleep feels better
Tested in people. Tested in people: sleep quality improved, with no harm in any study.
Warm bath or shower
Pleasantly warm water at 40–42.5 °C, 1–2 hours before bed. Ten minutes is enough, a shower is fine too.
- Not scalding, just warm
- Not right before bed, but an hour or two earlier
- Faster sleep onset in the studies
Tested in people. Tested in people: a warm bath was linked with faster sleep onset and better-feeling sleep.
Movement by day
Regular exercise improves sleep. Which kind hardly matters: walking, cycling, swimming, strength training.
- No effect of how hard it is was found
- You fall asleep faster, sleep is better
- Even one workout helps a little
Tested in people. Tested in people: regular exercise gave a moderate improvement in sleep quality.
Meditation
10–20 minutes a day: watching the breath, the body and sounds without judging anything. Helps those kept awake by racing thoughts.
- A course of several weeks
- By day or in the evening
- The effect remains after the course
Tested in people. Tested in people: sleep was better than with placebo-type activities of the same length.
A plan for the month
Not everything at once: add one step a week and keep a sleep diary.
- Week 1: same wake-up time, movement, warm bath
- Week 2: music before bed, bed only for sleep
- Week 3: meditation; week 4: review the diary
Who should see a doctor first
If insomnia is long-standing or other signs have joined it — see a doctor first.
- Insomnia longer than three months, three nights a week or more
- Snoring with pauses in breathing — check for apnoea
- Low mood, anxiety, pain or another illness
Important. Choosing treatment, including medication, is done individually with a doctor. These five ways complement it, they do not replace it.
In one sentence
Sleep therapy, music, a warm bath, movement and meditation — five proven ways to sleep better without pills. Start with one and add a step a week.
Key points
Five ways to sleep better without medication, each with meta-analysis data in people. Below — what exactly the studies showed and how to apply it.
| Remedy | What it helps with | What studies in people showed |
|---|---|---|
| Cognitive behavioural therapy for insomnia (CBT-I) | Teaches you to fall asleep and stay asleep | 20 trials, 1,162 people: sleep onset 19 min faster, awakenings 26 min shorter, sleep efficiency +9.9 percentage points (Trauer 2015) |
| Music before bed | Calmer sleep onset, better sleep quality | Cochrane 2022, 13 trials, 1,007 people: sleep quality on the PSQI better by 2.79 points out of 21 (Jespersen 2022) |
| Warm bath or shower | Faster sleep onset | 17 studies: water 40–42.5 °C 1–2 h before bed, from 10 min — associated with significantly faster sleep onset and better sleep quality and efficiency (Haghayegh 2019) |
| Regular physical activity | Better sleep quality, faster sleep onset | 66 studies: moderate effect on sleep quality, small-to-medium on sleep onset (Kredlow 2015) |
| Mindfulness meditation | Better sleep quality | 18 trials, 1,654 people: better than placebo-type activities, effect holds at follow-up (Rusch 2019) |
Cognitive behavioural therapy for insomnia
CBT-I is not “talking about problems” but a set of concrete techniques: bed only for sleep, getting up at the same time, cutting time in bed down to actual sleep, working with anxious thoughts (“I won’t fall asleep again”) and relaxation. In the trials, programmes included at least three such techniques (Trauer JM Ann Intern Med 2015. PMID 26054060[1]).
A meta-analysis of 20 randomised trials, 1,162 people with chronic insomnia (64% women, mean age 56): sleep onset 19.0 minutes faster, wake after sleep onset 26.0 minutes shorter, sleep efficiency — the share of time in bed actually spent asleep — 9.9 percentage points higher. The improvements seemed to hold at later measurements, and no adverse outcomes were reported (Trauer JM Ann Intern Med 2015. PMID 26054060[1]).
On average, sleep onset was 19 minutes faster and night-time wakefulness 26 minutes shorter than in the control groups. That is why CBT-I is recommended as first-line treatment for chronic insomnia — before pills. More on sleep hygiene in the article “Insomnia: the sleep formula”.
Music before bed
A 2022 Cochrane review: 13 trials, 1,007 adults with sleep complaints. Participants listened to recorded music for 25–60 minutes every day — from three days to three months (Jespersen KV Cochrane Database Syst Rev 2022. PMID 36000763[2]).
Sleep quality on the Pittsburgh Sleep Quality Index (PSQI; scale 0–21, lower is better) improved by 2.79 points compared with those who changed nothing — 10 trials, 708 people, moderate-certainty evidence; in size that is about one standard deviation. By participants’ own accounts sleep may have come sooner, lasted longer and been more efficient (3 trials, 197 people, low certainty). No trial reported any adverse events (Jespersen KV Cochrane Database Syst Rev 2022. PMID 36000763[2]).
How to apply: calm music without lyrics or familiar slow pieces, played quietly, 25–60 minutes before bed, every evening. The effect builds up over a course, not in one evening.
Warm bath or shower
The 2019 meta-analysis gathered 17 studies, 13 of them entered the calculations. Water at 40–42.5 °C was associated with better sleep quality and efficiency as rated by participants themselves, and a bath or shower 1–2 hours before bed lasting as little as 10 minutes — with significantly faster sleep onset (Haghayegh S Sleep Med Rev 2019. PMID 31102877[3]).
The proposed mechanism: warm water widens the vessels of the palms and soles, the body sheds heat through the skin more actively, and core temperature falls faster — and it is this fall that the body reads as the signal for sleep; the exact mechanism is still being studied (Haghayegh S Sleep Med Rev 2019. PMID 31102877[3]).
How to apply: not scalding, but pleasantly warm water at 40–42.5 °C; 1–2 hours before bed, not right before it; 10–15 minutes. The meta-analysis included both baths and showers.
Regular physical activity
A meta-analysis of 66 studies: regular exercise gave a moderate improvement in sleep quality, a small-to-medium speeding up of sleep onset, and a small increase in total sleep time and sleep efficiency. Even a single workout slightly improved sleep, and night-time waking after it was shorter (Kredlow MA J Behav Med 2015. PMID 25596964[4]).
An important detail: no effect of exercise intensity or of its aerobic or strength character was found; the result depended on sex, age, baseline activity, type of exercise, time of day, duration and how well the person stuck to the programme (Kredlow MA J Behav Med 2015. PMID 25596964[4]).
In people aged 60 and over with insomnia, the Cochrane review found one trial of 43 people: after an exercise programme sleep onset became faster, sleep longer and the overall sleep rating better; sleep efficiency did not change significantly (Montgomery P Cochrane Database Syst Rev 2002. PMID 12519595[5]).
How to apply: any activity you enjoy and can keep up regularly — walking, cycling, swimming, strength training. No effect of intensity was found in the meta-analysis — sticking to the programme matters more.
Mindfulness meditation
A meta-analysis of 18 randomised trials, 1,654 people: compared with placebo-type activities matched for time and attention, mindfulness meditation improved sleep quality — effect size 0.33 right after the course and 0.54 at follow-up, moderate-strength evidence (Rusch HL Ann N Y Acad Sci 2019. PMID 30575050[6]).
How to apply: 10–20 minutes a day — observing the breath, the body, sounds without judgement; a course of several weeks. Suits those kept awake by racing thoughts. On the link between stress and sleep — see “The stress axis, sleep and energy”.
How to combine them: a four-week plan
- Week 1. Get up at the same time every day, weekends included; 30 minutes of movement during the day; 1–2 hours before bed — a warm bath or shower for 10–15 minutes.
- Week 2. Add music for 25–60 minutes before bed; bed is for sleep only; if you cannot sleep for longer than 20 minutes — get up and come back when you feel sleepy.
- Week 3. Add 10–20 minutes of mindfulness meditation during the day or evening; cut time in bed down to actual sleep plus half an hour.
- Week 4. Review the sleep diary: how long you take to fall asleep, how many times you wake. If there is no improvement — time to talk to a doctor.
Who should see a doctor first
- Insomnia for longer than three months, three nights a week or more.
- Snoring with pauses in breathing, daytime sleepiness at the wheel — sleep apnoea needs to be ruled out.
- Low mood, anxiety, pain or another illness that disturbs sleep.
- Choosing treatment, including medication, is done individually with a doctor: the remedies in this article complement it, they do not replace it.
Caveats
- CBT-I. The meta-analysis included only trials of face-to-face multi-component programmes and only chronic insomnia without comorbid conditions; the 7.6-minute increase in total sleep time did not reach statistical significance (Trauer JM Ann Intern Med 2015. PMID 26054060[1]).
- Music. No difference in insomnia severity was shown (2 trials, 63 people, very low certainty); objective instrument measurements of sleep in 3 trials (136 people) showed no improvement — the effect is shown by self-rating. Participants could not be unaware they were listening to music, so the risk of bias is high in all trials (Jespersen KV Cochrane Database Syst Rev 2022. PMID 36000763[2]).
- Bath. There are few studies, the optimal timing and duration are still being clarified; the meta-analysis abstract gives no effect-size numbers (Haghayegh S Sleep Med Rev 2019. PMID 31102877[3]).
- Exercise. The size of the effect depended on sex, age and baseline activity; in people over 60 the Cochrane data come from one small trial, which the authors ask to be interpreted with caution (Kredlow MA J Behav Med 2015. PMID 25596964[4]; Montgomery P Cochrane Database Syst Rev 2002. PMID 12519595[5]).
- Meditation. Compared with specialised sleep treatment (sleep treatment of proven efficacy) no difference was shown — low-strength evidence (Rusch HL Ann N Y Acad Sci 2019. PMID 30575050[6]).
This material is for information only and does not replace a consultation with a doctor. The treatment plan for insomnia, including medication, is chosen by the treating physician.
References
- Trauer JM Ann Intern Med 2015. PMID 26054060
- Jespersen KV Cochrane Database Syst Rev 2022. PMID 36000763
- Haghayegh S Sleep Med Rev 2019. PMID 31102877
- Kredlow MA J Behav Med 2015. PMID 25596964
- Montgomery P Cochrane Database Syst Rev 2002. PMID 12519595
- Rusch HL Ann N Y Acad Sci 2019. PMID 30575050
Key facts
- Cognitive behavioural therapy for insomnia: in 20 trials with 1,162 people, falling asleep became 19 minutes faster, night-time awakenings 26 minutes shorter and sleep efficiency 9.9 percentage points higher (Trauer JM, Ann Intern Med 2015).
- Music before bed for 25–60 minutes a day: Cochrane review 2022 (13 trials, 1,007 people) — sleep quality on the PSQI scale better by 2.79 points out of 21 (Jespersen KV, Cochrane 2022).
- A warm bath or shower at 40–42.5 °C, 1–2 hours before bed, for at least 10 minutes: associated with significantly faster sleep onset and better sleep quality and efficiency (Haghayegh S, Sleep Med Rev 2019).
- Regular physical activity: across 66 studies — moderate improvement in sleep quality and faster sleep onset; no effect of exercise intensity was found (Kredlow MA, J Behav Med 2015).
- Mindfulness meditation: 18 trials, 1,654 people — better sleep quality than with placebo-type activities, and the effect held at follow-up (Rusch HL, Ann N Y Acad Sci 2019).
