BEHAVIORAL STRATEGIES, INCLUDING EXERCISE, FOR ADDRESSING INSOMNIA
Open accessAbstract
Cognitive-behavioral therapy for insomnia is superior to sleeping pills for treating insomnia, and its accessibility is rapidly improving. Exercise can also promote sleep in insomnia. A list of recommendations on good sleep practices can be applied prior to consulting with a clinician and can often resolve insomnia symptoms. SUMMARY STATEMENT: Insomnia is associated with negative psychological and physiological health outcomes. Established behavioral strategies for addressing insomnia such as adoption of good sleep habits and engagement in Cognitive Behavioral Therapy for Insomnia have documented efficacy. Exercise is also efficacious with unique health benefits.
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Bright morning light exposure, particularly within the first hour of waking, suppresses melatonin, advances circadian timing, and strengthens a stable sleep-wake rhythm.
“Conversely, bright morning light exposure, particularly within the first hour of waking, suppresses melatonin, advances circadian timing, and strengthens a stable sleep-wake rhythm [51].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [51]
The Sleep Hygiene Intervention section says early morning light advances circadian rhythms and sunlight helps anchor them to the light–dark cycle. It does not specify exposure within the first hour of waking; its discussion of melatonin suppression concerns light exposure after melatonin onset, not morning light. Page numbers are unavailable in our copy. (LLM, conf=0.88)
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“Due to the limited efficacy and significant safety concerns, Z-drugs (zopiclone, zale-plon, and zolpidem) in people with dementia should generally be avoided, with treatment decisions guided by the Beers criteria and a preference for non-pharmacological strategies whenever possible [240].”
Effects of exercise training and exercise plus acupuncture on chronic insomnia: a feasibility study
Ferreira, W. S., Santana, M. G., Youngstedt, S. D., de Assis, D. E., de Assis, B. P., de Cerqueira, D. P., Mazzaro, M. C., & Passos, G. S. (2022) · Sleep Science · doi:10.5935/1984-0063.20220053 · Cited by 11 · see citing works
“Regular exercise has been a promising alternative treatment in the last couple of decades 7,8 .”
BackgroundSelf-citationNutakor, J. A., Zhou, L., Larnyo, E., Gavu, A. K., Chohan, I. M., Addai‐Dansoh, S., & Tripura, D. (2023) · International Journal of Public Health · doi:10.3389/ijph.2023.1605876 · Cited by 7 · see citing works
“It is advised that this group adhere to a regular sleep schedule, maintain a pleasant sleep environment, participate in physical exercise, and avoid stimulants such as caffeine and electronic screens before bedtime [6].”
BackgroundForeign Contaminants Target Brain Health
Agarwal, U., Pannu, A. S., & Tonk, R. K. (2025) · CNS & Neurological Disorders - Drug Targets · doi:10.2174/0118715273338071241213101016 · Cited by 6 · see citing works
Schmickler, J. M., Blaschke, S., Mess, F., Olson, N., Reiner, B., Schulz, T., & Friedrich, J. (2025) · BMC Psychology · doi:10.1186/s40359-025-03280-0 · Cited by 8 · see citing works
The Treatment of Dually Diagnosed Individuals with Sleep Disturbances and Intellectual Disabilities
McPherson, P., Kaushal, M., & Kothapalli, V. (2020) · Autism and child psychopathology series · doi:10.1007/978-3-030-46835-4_36 · Cited by 5 · see citing works
Hbaieb, M. A., Bosquet, L., Hammouda, O., Hbaieb, R., Mezghani, I., Charfeddine, S., Abid, L., Turki, M., Driss, T., & Dugué, B. (2025) · Clinical Cardiology · doi:10.1002/clc.70183 · Cited by 5 · see citing works
“Reduced vagal tone and increased sympathetic activity impair sleep initiation and fragment sleep architecture [61].”
Daily physical activity and sleep in veterans: the role of insomnia severity
Robinson, S. A., Reilly, E. D., Petrakis, B. A., Wiener, R. S., Castaneda‐Sceppa, C., & Quigley, K. S. (2021) · Journal of Behavioral Medicine · doi:10.1007/s10865-021-00260-8 · Cited by 4 · see citing works
Gonçalves, S. D. (2025) · Exploration of Medicine · doi:10.37349/emed.2025.1001355 · Cited by 4 · see citing works
To, N. M., Ngo, Q. C., Polus, B., Dinh, M. N., Khandoker, A. H., Menon, A., & Kumar, D. (2025) · Computer Methods and Programs in Biomedicine · doi:10.1016/j.cmpb.2025.109122 · Cited by 3 · see citing works
Ferreira, D. P., Passos, G. S., Youngstedt, S. D., & Santana, M. G. (2026) · Physiology & Behavior · doi:10.1016/j.physbeh.2026.115225 · Cited by 2 · see citing works
Self-citationLi, A., Huang, R., Ge, H., Liu, D., Liu, S., Jia, Y., Chai, J.-Y., Zheng, X.-Y., Liu, L.-J., Gan, C., et al. (2024) · Journal of Cancer Research and Clinical Oncology · doi:10.1007/s00432-024-06065-x · Cited by 2 · see citing works
From streets to sleep: The impact of urban walkability on sleep health
Yoon, Y., & Oh, Y. (2026) · Journal of Transport & Health · doi:10.1016/j.jth.2026.102267 · Cited by 1 · see citing works
Chawla, V., Burgess, J. D., Lagera, P. G. D., & Noordsy, D. L. (2025) · Springer eBooks · doi:10.1007/978-3-031-82888-1_15 · Cited by 1 · see citing works
Nobre, T. D. S., Santana, M. G., Youngstedt, S. D., & Passos, G. S. (2025) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2025.07.006 · Cited by 1 · see citing works
Self-citationEverly, G. S., & Lating, J. M. (2019) · Springer eBooks · doi:10.1007/978-1-4939-9098-6_23 · Cited by 1 · see citing works
Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice.
Song, S., Irfan, M., Tahir, Z., Garrison, K. A., & Ziskind, S. (2026) · Current Sleep Medicine Reports · doi:10.1007/s40675-026-00370-2
The Treatment of Dually Diagnosed Individuals with Sleep Disturbances and Intellectual Disabilities
Monceaux, B., Smith, K., & McPherson, P. (2024) · Autism and child psychopathology series · doi:10.1007/978-3-031-66902-6_16
INFLUÊNCIA DA PERSONALIDADE E HIGIENE DO SONO NA INSÔNIA
Martinelli, J. C., Milanezi, M. P., Frauches, D. D. O., & Pacheco, J. P. G. (2025) · Revista Multidisciplinar do Nordeste Mineiro · doi:10.61164/remunom.v1i1.3408
Huang, S., Kim, J. E., & Li, W. (2025) · Asian/Pacific Island Nursing Journal · doi:10.2196/70226
“In addition to Qigong, a conventional Western sleep regimen was also used to enhance our therapy for insomnia [10-13].”
Li, L., Liang, J., & Fan, T. (2025) · Frontiers in Neurology · doi:10.3389/fneur.2025.1412152
Sleep Disturbance in People With Stroke: Experiences, Coping Strategies, and Needs
Hood, T. R., Landsness, E. C., Baum, C. M., Lau, K. K., Fong, K. N. K., Skidmore, E. R., & Lau, S. C. L. (2025) · OTJR Occupational Therapy Journal of Research · doi:10.1177/15394492251364743
“…(e.g., leaving the bedroom when unable to sleep, maintaining a consistent sleep-wake schedule) align with established sleep medicine principles (Markwald et al., 2018), and Borbély’s model: consistent sleep-wake schedules support circadian rhythms (Process-C), while limiting time awake in bed…”
The clinical value of circadian biofeedback in chronic heart failure
van Es, V. A. A., Lathauwer, I. L. J. D., Blerck, F. J. C. V., van Leunen, M. M. C. J., van de Sande, D. A., Brouwers, R. W. M., Funk, M., Ricciardi, E., Handjaras, G., Betta, M., et al. (2026) · European Heart Journal - Digital Health · doi:10.1093/ehjdh/ztag036
“…HR downslope and wake time to the HR upslope provides a physiological scaffold for sleep–wake cycles, consistent with chronobiological principles 13,28 In CHF, better sleep quality and preserved nocturnal vagal activity are associated with improved metabolic function and prognosis, 3,12…”
The Effect of Muscle-Damaging Exercise in the Heat on Sleep
Keefe, M. S., Dunn, R. P., Appell, C. R., Jiwan, N. C., Luk, H., Rolloque, J.-J. S., & Sekiguchi, Y. (2026) · Sports Health A Multidisciplinary Approach · doi:10.1177/19417381261423565
“31 conclusion Performance of a single bout of muscle-damaging exercise under heat stress increases the duration of total sleep, SWS, and REM sleep, without altering sleep architecture (ie, relative proportions of sleep stages).”
Mental Health Strategies for Managing Diabetic Neuropathy
Pramanik, S., Yadav, M. K., Patel, D., Shrivastava, A., Saxena, N., & Negi, S. S. (2026) · Springer eBooks · doi:10.1007/978-981-95-9326-2_20
Tsai, C.-S., Szewczyk, W., Lee, H., Drerup, M. L., Blakeney, E. A., Greenlee, H., Heffner, J. L., Vasbinder, A. L., & Reding, K. W. (2026) · JMIR Formative Research · doi:10.2196/85386
“To effectively alleviate these sleep disturbances, several nonpharmacological interventions have been investigated in prior research, such as cognitive behavioral therapy for insomnia (CBTi) and physical activity [13].”
Furuya, A., Makarem, N., Whalen, A., Merriman, J., Callander, D., Radix, Å., Kawanami, M., & Duncan, D. T. (2026) · The Journal of LGBTQ+ Mental Health · doi:10.1080/30678935.2026.2713222
“Those who reported taking longer than 30 min to fall asleep three or more times a week in the past month were classified as having long sleep onset latency; this cutoff is the most similar to the International Classification of Sleep Disorders definition of insomnia disorder (Markwald et al., 2018).”
- Authors
- Markwald, R. R., Iftikhar, I., & Youngstedt, S. D.
- Affiliations
- Emory University (US)
- Venue
- ACSM'S Health & Fitness Journal
- Published
- 2018-03
- Volume
- 22
- Issue
- 2
- Pages
- 23-29
- ISSN
- 1091-5397 (ISSN-L)
- PMC
- PMC6715137
- OpenAlex
- W2796070172
- Cited by
- 31
- References
- 65
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 5 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 1
- FWCI
- 0.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- ACSMʼs Health & Fitness Journal (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Veterans Affairs (I01 CX000898)
- National Heart, Lung, and Blood Institute (R01HL095799)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- insomnia, cognitive behavioral therapy for insomnia, physical activity, sleep habits, sleep hygiene, hypnotics, behavioral sleep interventions
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