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.