These 3 exercises may help with insomnia, new study finds

CNN

6 days ago

Tossing and turning every night? Doing more physical activities throughout the week is a known way to improve sleep, but new research shows you don't have to run a marathon or visit a gym to reap those benefits.
Low-intensity, low-impact exercise can improve sleep and ease the symptoms of insomnia, according to a new meta-analysis of 22 randomized clinical trials published Tuesday in the journal BMJ Evidence-Based Medicine.
The trials involved 13 non-pharmaceutical insomnia treatments, including seven fitness regimens, acupuncture, massage and cognitive behavioral therapy.
Among the exercises studied, yoga, tai chi, and walking or jogging showed the most promising evidence of helping participants fall asleep faster and stay asleep longer, with less awakenings.
'Growing evidence suggests that regular physical activity not only improves physical health, but also enhances sleep quality,' said Zhi-jun Bu, the study's first author and a doctoral student in clinical medicine at the Nanjing University of Chinese Medicine, in an email. 'However, most existing studies focus on just one type of exercise, lacking comprehensive comparisons.'
The research points to potential cost-effective, drug-free alternatives to traditional insomnia treatments, and further understanding the unique benefits of each exercise could be the next step, said Bu, who conducted the research when he was pursuing his master's degree at Beijing University of Chinese Medicine.
It's not unusual to struggle with frequent bouts of restlessness. About 14.5% of adults reported trouble falling asleep most days or every day in the past month, according to a 2020 survey by the US Centers for Disease Control and Prevention.
In a clinical setting, insomnia is generally diagnosed when someone has trouble falling asleep and experiences frequent, drawn-out sleep disruptions three times or more per week, said Dr. Shalini Paruthi, an adjunct professor of internal medicine and pediatrics at St. Louis University School of Medicine and spokesperson for the American Academy of Sleep Medicine.
Long-term insomnia can stem from a wide array of environmental and hereditary causes, including stress, poor sleep habits, chronic pain, medications or other sleep disorders such as sleep apnea, Paruthi said.
Typically, the first line of treatment for insomnia involves cognitive behavioral therapy, or CBT, a psychological approach aimed at adjusting patients' thoughts, feelings and behaviors around sleep.
'It's common (for patients with insomnia) to lose hope about getting sleep at night, to anticipate they're just going to lay in bed with a racing mind,' Paruthi said. 'CBT allows them to reconsider how they're approaching and thinking about sleep.'
Unlike other talk-oriented therapies, CBT does not require delving into a patient's past experiences or traumatic events, Paruthi said. Rather, the approach helps patients develop techniques to relax the mind and transition into sleep.
'We have very strong evidence that CBT can work just as good as medication, and it can last longer, because people are making new habits,' Paruthi said, adding that patients with insomnia typically see improvement in their symptoms after two to six weeks of therapy.
Exercise, on the other hand, is not considered a first-line treatment for insomnia in any clinical guidance literature. Still, Paruthi said she frequently recommends 150 minutes of moderate-intensity physical activity per week alongside other methods.
Important note: Before beginning any new exercise program, consult your doctor. Stop immediately if you experience pain.
Out of the randomized clinical trials Bu's team analyzed, these three physical activities had the best evidence behind their efficacy as a stand-alone treatment for insomnia.
Yoga: Two to six 45- to 60-minute sessions of yoga per week over one to four months increased total sleep duration by nearly two hours per night and reduced instances of waking after falling asleep by an hour.
'Yoga can promote better sleep by encouraging deep breathing, body awareness and a calm mental state, which helps reduce stress and anxiety — two common triggers of insomnia,' Bu suggested.
Tai chi: Two to three 45- to 60-minute sessions per week over three to four months increased total sleep duration by more than 50 minutes and reduced time spent awake by over 30 minutes.
The Chinese martial art involves combining a series of flowing, low-impact movement with deep, slow breathing that may help reduce stress and calm the body, Bu said.
Walking or jogging: Three to five 30- to 75-minute sessions per week over three to six months were shown to reduce symptoms of insomnia based on standardized scoring systems used in clinical settings.
'Walking or jogging improves sleep through both physical and emotional pathways: It increases energy expenditure, lowers stress hormones like cortisol, boosts mood, enhances melatonin production (the hormone that regulates sleep) and promotes deeper, more restorative sleep — ultimately helping to reduce insomnia symptoms,' Bu said.
Further research is needed to develop standardized regimens and understand the benefits of other exercises, Bu said. This information could help providers tailor their recommendations to the sleep challenges of their individual patients with insomnia.
While Paruthi said the evidence of the meta-analysis is a compelling case for exercise as a complementary treatment, she wouldn't routinely recommend it as the only remedy.
'If a patient wants to try exercising more, I say to start slow, build up that intensity and frequency over time, but listen to your body and observe how it is improving your sleep,' Paruthi said.
Timing your physical activity is important, too, she said. Exercise earlier in the day can make you feel alert, but an intense workout right before bed could make it harder to fall asleep.
'The most important thing is to choose something sustainable. … Sometimes it's easy to set lofty goals,' Paruthi said. '(With patients) we discuss what are some exercises they can routinely do and really stick to.'
If lifestyle changes alone aren't doing the trick, it may be time to visit a sleep specialist, she said.
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