Treatment Overview
Insomnia is often a symptom of another condition rather than a condition of its own. If insomnia is caused by medical or psychological conditions, treatment will focus on those underlying conditions. When poor sleep quality itself is the major problem, medications can be prescribed short-term to relieve symptoms.
Recently, there has been increasing support for therapies that involve modifying behavior and lifestyle. These two approaches—sedative-hypnotic medications and behavior therapies—may be prescribed together, with the medications helping to provide a good night's sleep in the short term and the therapies helping you to develop long-lasting changes in approaches to sleep.
* Work with your health professional to first try to determine whether another condition—such as depression, anxiety, pain, use of stimulants or medications, inactivity, or poor sleep habits—is causing your insomnia, and treat the underlying cause.
* You may be able to treat your insomnia with minor lifestyle changes, such as modifying your sleep environment, your schedule, or what and when you eat and drink and getting more activity.
* Sleep-inducing medications can be used if other types of treatment don't work. But medication should only be used intermittently, and it is not considered the first treatment of choice for long-term insomnia.
Behavior therapy
Getting ready for bed means more than turning down the sheets. Sleep therapists know that there are many factors involved in a person's ability to sleep well. Here are examples of therapies that help you develop habits and beliefs that will promote good sleep quality.
* Relaxation therapy may be successful for people with poor sleep habits who lie in bed with their minds racing. This therapy teaches progressive muscle relaxation, in which different muscle groups are tensed and relaxed, as well as attention-focusing techniques such as meditation, which can help stop sleep-disturbing habits.
* Cognitive-behavioral therapy helps you to recognize certain beliefs you hold about yourself and sleep, to change those beliefs that may contribute to unhealthy patterns, and to introduce positive behaviors that will help you create an inviting environment for sleep. Studies of cognitive-behavioral therapy's effect on people with insomnia have shown good, lasting results in reducing interrupted sleep. 14
* Sleep hygiene measures are simple actions that address sleep habits and factors that may keep you from good sleep. For example, keep regular bedtimes and wake times—7 days a week—and try to avoid taking naps during the day. For more information, see:
o How to set up a healthy sleep environment.
* Stimulus-control therapy reestablishes the bed as a place for sleeping and sex only—not for sleeplessness. For example, if you can't fall asleep in 15 minutes, you get out of bed and do something quiet and relaxing until you are sleepy again.
* Sleep-restriction therapy limits the time spent in bed to time spent sleeping.
Medications
Sleep medications may provide rapid relief of the symptoms of insomnia. However, many of these medications have side effects (such as high blood pressure, anxiety, nausea, decreased effectiveness when your body becomes accustomed to the medications [tolerance], and withdrawal effects), and they have not been shown to be effective for long-term treatment of insomnia. 10
* Hypnotic medications help you fall asleep or stay asleep.
* Antidepressants that have a calming or sedative effect can be used to aid sleep.
* Antihistamines, typically used for allergies, can be effective for short-term relief of sleeplessness.
* Nonprescription medications for sleep, or sleeping pills, can help but also can have side effects—such as becoming habit-forming and causing increased sleep problems when the medications are stopped (rebound insomnia)—and should not be used for more than 7 to 10 days.
* Rozerem is a new type of sleep medicine that helps regulate your body's internal clock. Rozerem has few side effects and is not habit-forming.
If you are taking any of these medications, it's usually best if you take them only for a short time, at the lowest effective dose, and stop taking them as soon as you can. 15 This is true for all people, but it is particularly true for older adults, who can become dependent on sleep enhancers and sometimes experience diminished thinking capability during and after long-term sleeping medication use. 16
The most successful long-term treatment results have been achieved with behavior therapy. Behavior therapy results in similar improvements in both overall sleep quality and less time in getting to sleep compared to using medications, without any side effects. 17 Up to 80% of people receiving such therapy benefit from the treatments, and about one-third become good sleepers. Perhaps most important, these results are maintained over time. 10
Complementary medicine
Other treatments for insomnia may include complementary and alternative medicines. Two of the most popular alternative medicines are:
* Valerian, a traditional herbal sleep remedy that appears to be safe and may improve sleep when taken for a week or two. 18
* Melatonin, a hormone produced by the brain that is available as a nutritional supplement. Some studies have shown it to be safe and effective for children with insomnia. 19, 20 It has also been used to treat jet lag and poor sleep due to shift work in adults.
