What can you do if you have trouble sleeping?

There are many different things you can do to change your bedtime habits. You can try them out at home or learn about them in a course. Research hasn't clearly shown which approaches are likely to work best.

Good “sleep hygiene” mainly involves making sure you have a pleasant space to sleep in and a regular sleeping pattern, and also adopting habits that help you sleep better. Things you can do include:

• Not drinking alcohol, coffee or tea and avoiding other stimulants four to six hours before going to bed.
• Not smoking before bedtime or during the night.
• Avoiding heavy meals and spicy foods before going to bed.
• Getting physical exercise during the day, but avoiding exercise right before going to bed.
• Making sure your bedroom is quiet, dark and not too hot or cold.
• Going to bed and getting up at around the same time every day.

It is also a good idea not to listen to loud music, or work or play on a computer or smartphone in the time before you go to bed. If background noise is disturbing your sleep, earplugs might be worth a try.

The aim of stimulus control is to help improve your sleep-wake cycle by creating a strong association between your bed and sleeping. A fixed schedule and specific bedtime habits are needed. For instance:

• Make it a basic rule to only go to bed when you feel tired.
• Get up if you are having difficulty getting (back) to sleep.
• Only use your bed for sleeping (and sex), and not for reading, watching TV or eating.
• Always get up at the same time in the morning.
• Get up as soon as the alarm clock goes off and don’t use the snooze function.

In this approach, you limit the time you spend in bed to the time when you’re actually asleep. For example, if you usually spend eight hours in bed, but only sleep six hours, then the idea is that you should reduce your time in bed so it’s not much more than six hours.

Keeping a sleep diary can help you work out how long you sleep on average. Once you know that, you can use your wake-up time to calculate the best time for you to go to sleep. For instance, if your alarm is set for 6:00 a.m. and you need six hours' sleep, you work backwards from 6:00 a.m., subtracting six hours plus half an hour to fall asleep. So 11:30 p.m. would be a good time to go to bed.

There are conflicting theories and research results about whether it's a good or bad idea to nap during the day. Some studies have looked at whether napping during the day can make up for not getting enough sleep at night, helping you to do things like drive more safely. Other researchers have studied whether napping helps you sleep better at night or perhaps even has the opposite effect, making you sleep worse at night instead. There are no clear results yet.

The aim of relaxation techniques is to relax your body and mind. They are meant to reduce physical tension and interrupt the thoughts that are affecting sleep.

There are different types of relaxation techniques, including:

• Progressive muscle relaxation, also called Jacobson's or deep muscle relaxation: This technique involves tensing groups of muscles all over the body one by one, and then consciously relaxing them again.
• Autogenic training: This approach involves focusing awareness on different parts of the body and consciously relaxing them. At an advanced level, even involuntary body functions like your pulse and breathing can be influenced in order to reach a very deep state of physical relaxation.
• Imagery (visualizations): Another common type of relaxation training is imagery, where you visualize peaceful, pleasant scenes or imagine yourself breathing quietly, gently falling asleep and having a good night's sleep.
• Breathing exercises and meditation.
• Gentle physical exercise like going for a walk, doing simple yoga exercises or tai chi.
• Listening to music, especially before going to sleep.
• Biofeedback: This method helps you to see how your body reacts to tension and relaxation. It involves placing electrodes on your body to measure muscle tension, your pulse and brain activity. You can monitor these different measurements on a screen and see how muscle relaxation or thinking particular thoughts affects them. Biofeedback can be done at the doctor's or by using a portable biofeedback device at home once you've been shown how to use it.

A lot of relaxation techniques can be learned in courses, an audio or online tutorial, or with the help of an app.

Exercise can help you relax. Exercise involving regular movements, such as jogging and brisk walking, is particularly good. But the research so far hasn't clearly shown that physical activity leads to a noticeable improvement in people with sleep disorders.

Some people who have trouble sleeping try acupuncture or acupressure. Various studies have been carried out on the effect of these treatments on sleep problems, but no clear conclusions can be drawn yet.

Sometimes, people use home remedies to try to get a better night's sleep. These include:

• Warm drinks: Drink a cup of warm milk, or chamomile or valerian tea
• Heat: Take a warm shower or bath, or soak your feet in warm water
• Essential oils like chamomile or lavender

People often find home remedies comforting. These remedies are unlikely to have any negative effects, but it's not clear whether they do actually help improve sleep. So, as with many issues surrounding sleep, the best thing to do is try things out and see what works best for you.

There are a number of online programs to help you improve your sleep. Most of them are apps that can be downloaded. Some are free, some have to be paid for. The things that they offer include sleep analysis, sleep training and guides for relaxation techniques.

In Germany, some apps can be prescribed by a doctor or therapist. They're referred to as "Digital Health Applications" (DiGAs) and they’re covered by statutory health insurance. DiGAs are assessed and certified by Germany’s Federal Institute for Drugs and Medical Devices (BfArM). This means they meet certain requirements to do with things like data privacy and content quality.

The BfArM can supply a list of all DiGAs that deal with sleep. The list contains additional information on the content of each app and what it does.