How Is Insomnia Treated?

Making lifestyle changes that make it easier to fall asleep and/or stay asleep can often relieve insomnia. For longer lasting insomnia, a type of counseling called cognitive-behavioral therapy can help relieve the anxiety linked to your sleep problem. Anxiety tends to prolong the insomnia. Several medicines also can help relieve insomnia and re-establish a regular sleep schedule.

Lifestyle Changes

To relieve insomnia, you should avoid substances that make it worse and have good bedtime habits that make it easier to fall asleep and stay asleep. Make sure your bedroom is a comfortable temperature, dark, and quiet enough for sleep.

Avoid substances such as:

• Caffeine, tobacco, and other stimulants taken too close to bedtime (effects of caffeine can take as long as 8 hours to wear off).
• Certain over-the-counter and prescription medicines that can disrupt sleep (for example, some cold and allergy medicines).
• Alcohol. An alcoholic drink before bedtime may make it easier for you to fall asleep. But alcohol triggers sleep that tends to be lighter than normal and makes it more likely that you will wake up during the night.

Good bedtime habits include:

• Following a routine that helps you wind down and relax before bed, such as reading a book, listening to soothing music, or taking a hot bath.
• Not exercising, eating heavy meals, or drinking a lot shortly before bedtime.
• Making your bedroom sleep-friendly. Avoid bright lighting and minimize possible sleep distractions, such as a TV, computer, or pet.
• Going to sleep around the same time each night and waking up around the same time each morning, even on weekends. If possible, avoid night shifts or alternating schedules at work and other causes of irregular sleep schedules.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy for insomnia targets the thoughts and actions that can disrupt sleep. Besides encouraging good sleep habits, this type of therapy may use several methods to relieve sleep anxieties, including:

• Relaxation training and biofeedback at bedtime to reduce anxiety. These strategies help you better control your breathing, heart rate, muscles, and mood.
• Replacing worries about not being able to fall asleep with more positive thinking that links being in bed with being asleep. This method also teaches you what to do if you’re unable to fall asleep within a reasonable period.
• Talking with a therapist individually or in group sessions to help you consider your thoughts and feelings about sleep. This method may encourage you to describe thoughts racing through your mind in terms of how they look, feel, and sound. The goal is for your mind to settle down and stop racing.
• Limiting the time you spend in bed while awake. This method involves setting a sleep schedule and, at first, limiting total time in bed to the typical short length of time you’re usually asleep. At first, this schedule may make you even more tired because some of the allotted time in bed will be taken up by difficulty sleeping. The resulting fatigue (tiredness) is intended to help you get to sleep more quickly. Gradually, the length of time spent in bed is increased until you get a full night of sleep.

For success with this type of therapy, you may need to see a therapist who is skilled in this approach weekly over 2 to 3 months. Cognitive-behavioral therapy is as effective as prescription medicine for many types of chronic insomnia. It also may provide better long-term relief than medicine alone.

Medicines

Several medicines cause sleepiness. Doctors sometimes prescribe sleep-inducing medicine for 1 to 2 weeks to help establish a regular sleep schedule. Insomnia medicine helps you fall asleep, but can leave some people feeling unrefreshed or groggy in the morning. You may also be groggy and should exercise caution if you must get up before getting a full night's sleep of 7 to 8 hours while taking these medicines. The Food and Drug Administration (FDA) hasn’t approved all insomnia medicines for continuous, long-term use. Your doctor can help you understand the benefits and potential problems if medicines will be needed for long periods.

Some people use natural remedies to treat their insomnia. These remedies include melatonin and L-tryptophan supplements and valerian teas or extracts. The FDA doesn’t regulate these over-the-counter treatments. This means that their dose and purity can vary from product to product. Their safety and effectiveness is not well understood.

Medicines also are available to treat symptoms of excessive sleepiness if your insomnia is the result of shift work or alternating work schedules. You should discuss your situation with your doctor to determine whether these medicines, together with improving sleep habits, can help you overcome insomnia.