Insomnia Treatment

People who experience insomnia symptoms for at least three nights a week for a month or longer should see their doctor for medical help. Some people may be referred to a sleep specialist at a Sleep Disorders Center for treatment.

The treatment for insomnia is based on its cause. Any medical or emotional conditions, a bad sleep environment, or disruptive sleep habits are treated first. If the insomnia remains, sleep medications may be prescribed to help people develop a regular sleep schedule.

If no cause of the insomnia is found, the diagnosis is primary insomnia and the treatment focuses on helping people develop lifestyle changes that promote sleeping.

Common insomnia treatments include:

Lifestyle changes
Non-drug therapies
Medications
Complementary and alternative medicine

Lifestyle Changes

The following lifestyle changes are designed to help people fall asleep more quickly and stay asleep during the night:

Avoid late-night eating and fluid consumption

Avoid consuming large meals or drinking too many fluids before going to bed.

Avoid stimulants late in the day

Taking stimulants later in the day may make it difficult for people to fall asleep and stay asleep at night. People are advised to avoid:

Caffeine after lunch
Alcohol later than the afternoon
Nicotine close to bedtime

Check medication side effects

Check all prescription and over-the-counter medications to see if any have the potential of causing sleep problems. For example, several allergy and cold medications may interfere with a person's ability to sleep. Using sleep medications and sedatives longer than a couple of weeks can also cause people to develop sleep problems.

Create a soothing sleep environment

People can improve their sleep environment by:

Minimizing the amount of light
Heavy curtains can limit the amount of light entering the bedroom from the street.
Decreasing the amount of noise
White noise machines create soothing, natural sounds that mask out noise that may interfere with a person's ability to sleep.
Regulating the temperature
If possible, regulate the bedroom's temperature to be slightly cool.

Establish a regular sleep schedule

People can help regulate their internal clock by establishing a regular sleep schedule. They should try to go to sleep and wake up at the same time every day of the week. People who are unable to fall asleep within 30 minutes should relax by listening to soothing music or reading, and then try again.

Unless advised otherwise, people should try to limit daytime naps to less than 30 minutes and never take a nap after 3:00 p.m. If possible, it's advisable to avoid jobs that require alternating day-night work schedules, night shifts, or long-distance travel.

Exercise during the day

Exercise helps people sleep at night, especially aerobic exercise (such as running, jogging, cycling, swimming, and dancing). Try to exercise at least one-half hour in the early part of the day and avoid strenuous activity late in the day.

Limit alcohol consumption at night

Although an alcoholic beverage in the evening helps people fall asleep, it's a lighter sleep, which makes it difficult for people to sleep through the night.

Relax in the evening

Techniques that help people relax in the evening include listening to soothing music and reading.

Treat pain

Any pain symptoms should be treated before going to bed. It's important, however, to avoid any medications that might interfere with sleep.

Non-Drug Therapies

The following non-drug therapies used in addition to medications may help people with insomnia.

Bright light therapy

Bright light therapy can advance or delay a person's internal clock (circadian rhythm). Bright light therapy helps with jet lag disorders and is especially helpful for older adults who find they need to go to sleep and wake up far earlier than normal. A Examples of bright light devices include:

Light box (people stay within a set distance from a box that produces very bright light)
Desk lamp (a light box made to resemble a desk lamp)
Light visor (a portable light that is worn on the head and hangs over the eyes)
Dawn simulator (a light that simulates sunrise by gradually makes a dark room lighter over time)

Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT) is actually a group of different psychological therapies that help people change any thought processes (cognition) and behaviors that interfere with their ability to sleep well. CBT helps people develop new habits that promote a healthy sleep.

Counseling

Psychological counseling is helpful when a person's insomnia is due to depression or anxiety.

Sleep disorder appliances

Sleep disorder appliances that help people with obstructive sleep apnea and snoring include:

Continuous positive airway pressure (CPAP)
CPAP provides a steady stream of air through a mask to the back of the throat, which keeps a person's airway open. It is used to treat obstructive sleep apnea.
Oral appliances
Oral appliances are worn in the mouth to protect a person's teeth and open their airway as they sleep. They are used to treat obstructive sleep apnea, snoring, and teeth grinding.

Support groups

Insomnia support groups provide coping suggestions, education, emotional support, social interaction, and help people avoid feelings of isolation.

Surgery

Surgery may be considered for sleep-related conditions (such as severe cases of obstructive sleep apnea) when more conservative treatments aren't successful. The appropriate treatment site and surgical procedure used depends on a person's specific anatomical features.

Medications

When lifestyle changes don't work, sleep medications can help people with insomnia get a full night's sleep. Sleep medications help people:

Fall asleep sooner
Sleep longer
Wake up during the night less frequently

Most people only require sleep medications for occasional or short-term use. Doctors may prescribe a sleep medication for a week or two to help establish a regular sleep schedule.

The FDA has asked manufacturers of sedative-hypnotic sleep medications (drugs that induce and/or maintain sleep) to strengthen their labeling so that consumers are more aware of the following possible risks:

Severe allergic reactions
Complex sleep-related behaviors, such as sleep-driving (driving while not fully awake with no memory of the event)

A doctor should be notified if any severe reactions occur while taking sleep medications. People should also ask their doctor or pharmacist in advance for possible drug side effects or interactions. It's important for people to be under medical supervision while taking sleep medications. Sleep medications may not be appropriate when a person's insomnia is due to a breathing disorder.

The following list of sleep medications isn't inclusive. Additional information, side effects, and drug interactions can be obtained by clicking the name of the highlighted medications.

Nonbenzodiazepines

Nonbenzodiazepines are sedative-hypnotic drugs that reduce the time it takes people to fall asleep and/or stay asleep. They work by depressing the activity of the central nervous system. Nonbenzodiazepines are metabolized more quickly than the benzodiazepines, which lessens the risk of side effects the following day when taking nonbenzodiazepines. Examples include:

eszopiclone (Lunesta)
zaleplon (Sonata)
zolpidem (Ambien, Ambien CR)

Rozerem

The sleep medication ramelteon (Rozerem) is a new type of sleep medication that works by targeting a person's circadian rhythm instead of depressing the central nervous system. Rozerem is prescribed for people who have difficulty falling asleep. It can be used long term and is less likely to cause dependence.

Benzodiazepines

Benzodiazepines are sedative-hypnotic drug that are not as commonly used today to treat insomnia. They have been replaced by newer sleep medications that are less likely to become habit forming, and cause drowsiness, headaches, or memory problems the following morning. Today, benzodiazepines are primarily prescribed for people who need a medication that stays in their system longer. Examples include:

Antidepressants

Some antidepressant medications cause drowsiness and may be prescribed for people who have trouble waking up in the middle of the night. When a person's insomnia is caused by depression, antidepressants can improve the person's insomnia in addition to the depression. Examples include:

Over-the-counter medications

Over-the-counter sleep medications often contain antihistamines, which make people drowsy by depressing the central nervous system. Although effective when used occasionally, they may create drowsiness during the day and become less effective over time.

diphenhydramine (Nytol, Sominex)
doxylamine (Unisom Nighttime Sleepaid)

Complementary and Alternative Medicine

Complementary and alternative medicine refers to those medical and healthcare treatments that are not part of traditional medicine. Whereas, complementary medicine is used with traditional medicine, alternative medicine is used in place of traditional medicine.

The following nontraditional therapies help treat insomnia. Some of these therapies haven't been well studied, and little information is available about their effectiveness, side effects, and drug interactions. It's important to discuss any of these therapies with a doctor before trying them.

Melatonin

Melatonin is a natural hormone that regulates sleep. It is produced by the pineal gland in the brain from the amino acid tryptophan. Melatonin's production is suppressed by light, stimulated by darkness, and highest in the blood right before bedtime. Melatonin supplements are used to treat insomnia and jet lag.

Valerian

The herb valerian is often used to treat insomnia. It is also used as a sedative and antianxiety treatment. Some valerian supplements also contain hops.

Hops

The hops flower is typically used to flavor beer. Hops also has sedative properties, and is used to treat anxiety and insomnia.

Relaxation techniques

The following relaxation techniques help relieve stress, anxiety, and insomnia:

Acupuncture
Acupuncture inserts sharp, thin needles into the body to adjust the body's energy flow into healthier patterns.
Biofeedback
Biofeedback uses special equipment to train people how to regulate their involuntary body functions related to stress, such as heart rate, blood pressure, or brain wave patterns.
Deep breathing
Deep breathing (diaphragmatic breathing) is a relaxation technique that involves breathing deeply into the lungs by flexing the diaphragm instead of the shallower flexing of the rib cage.
Qi gong
Qi gong is an ancient Chinese system of breathing techniques, exercises, meditations, and postures designed to improve and enhance the body's health and vitality.
RESPeRATE Blood Pressure Lowering Device
RESPeRATE is an FDA-approved portable electronic device that helps relieve stress naturally by helping people to master the technique of paced breathing.
Yoga
Yoga is a Hindu system that is believed to prevent diseases by a combination of breathing techniques, meditation, and physical exercises designed to strengthen the body and calm the nervous system.

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