Exercise
Sleep and exercise bound a reciprocal relationship involving physical
and psychical pathways. Multiple explanations of how regular exercise
affects sleep comprise endocrine effects on the hypothalamic level41, the interaction with circadian rhythm, metabolic
and immune responses, and thermoregulatory.42
Resistance exercise, aerobic training, and stretching. In 2018,
Kovacevic and colleagues conducted a systematic review to determine the
acute and chronic effects of resistance exercise on sleep quality.
Regular resistance exercise significantly improved sleep quality, with
additional benefits of a combination with aerobic exercise. On the other
hand, the evidence of the acute effects of resistance exercise on sleep
quality was low and inconsistent.43 In 2019, D’Aurea
et al. conducted a study comparing the effects of moderate-intensity
resistance exercise training and stretching on chronic insomnia. The
authors found both approaches to be similarly effective in objective and
subjective sleep parameters. Compared with controls, either resistance
exercise and stretching were effective.44 In their
study, Bullock and coworkers compared the influence of different
exercise intensities on sleep quality in older poor sleepers. Their
results suggest that high-intensity interval training (HIIT) was the
least effective for optimizing sleep in poor sleepers compared with
moderate and low (stretching) intensity exercise.45According to sleep hygiene, people should not perform exercise before
bedtime. On the other hand, Buman and coauthors did not find an
association between evening exercise and worse
sleep.46 Thus, it seems that one should evaluate
evening exercise’s influence on sleep quality case by case. To this end,
regular exercise seems to be a good alternative treatment option for
poor sleepers.
Tai Chi Chuan, an internal Chinese martial art, is nowadays also
very popular in the Western world. A systematic review with a
meta-analysis conducted in 2014 showed the potential to enhance older
adults’ cognitive function who practice Tai Chi.47 A
favorable impact of Tai chi on the occurrence of falls, cardiovascular
fitness, and flexibility was also reported.48,49 In
2010, Wang and coworkers, in their systematic review, documented the
effects of Tai Chi on improvement in psychological well-being, including
mood, decreased stress, and anxiety.50 Two recently
published systematic reviews with meta-analyses have reported sleep
quality improvement via Tai Chi training.51,52
Yoga , in its ancient spiritual concept, originated in the Indian
subcontinent more than 5.000 years ago, comprises meditation, breathing
exercises, lifestyle advice, and body positions. The Western version,
known as ’modern postural yoga’ consists mainly of postures usually
connected by flowing sequences.53 Cramer et al., in
their systematic review from 2013, documented moderate evidence for
short-term effects of yoga on symptom relief in patients with
depression.54 Considering women with sleep problems,
Wang and coworkers reported that yoga intervention could be beneficial
in the long-term.55 Furthermore, yoga practice has
also been reported to be helpful in primary insomnia56, and it was shown to improve sleep in the
elderly57, cancer patients 58, and
women with menopausal symptoms.59 However, European
guidelines for the diagnosis and treatment of
insomnia12 do not recommend yoga for the treatment of
insomnia because of poor evidence.