Struggling to fall asleep night after night can trigger bedtime anxiety. Insomnia is one of the most common sleep disorders, affecting about 10% of the population, says Michelle Drerup, Psy.D., director of behavior sleep medicine at Cleveland Clinic. To put the vicious cycle to bed, sleep experts say that relaxation techniques and a biofeedback device (some are available for home use) can measure the effects of these exercises to let patients know what’s working and what’s not. Here, Drerup explains how biofeedback is used to treat insomnia.

How exactly does biofeedback therapy work?

Michelle Drerup: Devices measure physiological activity, such as breathing, heart function, and muscle activity. Electrodes connected to the body quickly and accurately “feed back” information on a computer, and patients use this to learn what relaxation techniques work. It can be helpful in treating conditions such as anxiety, chronic pain, and migraines.

How can that help with insomnia?

Drerup: Patients with insomnia may have muscle tension as well as short, shallow breathing. If, for instance, you tend to carry tension in the neck and shoulders, electrodes from a device that measures heart rate, respiration, and/or muscle tension will be hooked up to these muscle groups to gauge the effectiveness of the relaxation techniques you are using. Your finger temperature may also be measured, as stress lowers blood flow to hands and feet.

So biofeedback is always used alongside relaxation therapy?

Drerup: Yes. For example, you can strap on a heart rate monitor. As you attempt to become more relaxed through progressive muscle relaxation or deep breathing, you can watch how your heart rate changes. I recommend using biofeedback therapy in conjunction with cognitive behavioral therapy—the first treatment recommendation for chronic insomnia disorder by the American College of Physicians and the American Academy of Sleep Medicine.

OK, what relaxation strategies can I try on my own?

Drerup: First, avoid caffeine, and put away anything with a bright screen an hour before bedtime. Set up a calming routine—take a warm bath, drink tea, meditate. Breathing slowly can also help: Inhale for a count of four and exhale for a count of six. If your mind still races when you hit the pillow, try problem-solving earlier so thoughts will be less likely to interfere with sleep.

Why is there so little research on biofeedback therapy?

Drerup: It’s not reimbursed well by insurance, so there’s little monetary incentive, and it doesn’t necessarily work better than relaxation therapy alone. But in my experience, patients who are more anxious or have a hard time relaxing on their own can benefit from it.