Insomnia - Treatment - Treatment

Lifestyle changes can often help improve short-term insomnia. A type of counseling called cognitive behavioral therapy for insomnia is usually the first treatment recommended for chronic insomnia. Several medicines can also help manage insomnia and help you have a regular sleep schedule. You may need to visit a doctor who specializes in treating sleep problems.

Healthy sleep habits

In addition to following a heart-healthy lifestyle, try to adopt the following bedtime habits. These habits can make it easier for you to fall asleep and stay asleep.

  • Make your bedroom sleep-friendly. Sleep in a cool, quiet place. Avoid artificial light from the TV or electronic devices, as this can disrupt your sleep-wake cycle.
  • Go to sleep and wake up around the same times each day, even on the weekends. If you can, avoid night shifts, irregular schedules, or other things that may disrupt your sleep schedule.
  • Avoid caffeine, nicotine, and alcohol close to your bedtime. Although alcohol can make it easier to fall asleep, it triggers sleep that tends to be lighter than normal. This makes it more likely that you will wake up during the night.
  • Get regular physical activity during the daytime (at least 5 to 6 hours before going to bed). Exercising close to bedtime can make it harder to fall asleep.
  • Avoid daytime naps, especially in the afternoon. This may help you sleep longer at night.
  • Eat meals on a regular schedule and avoid late-night dinners. This helps maintain a regular sleep-wake cycle.
  • Limit how much fluid you drink close to bedtime. This may help you sleep longer without having to use the bathroom.
  • Learn new ways to manage stress. Follow a routine that helps you wind down and relax before bed. For example, read a book, listen to soothing music, or take a hot bath. Your doctor may also recommend massage therapy, meditation, or yoga to help you relax. Acupuncture may also help improve insomnia, especially in older adults.
  • Avoid certain over-the-counter and prescription medicines that can disrupt sleep (for example, some cold and allergy medicines). Talk with your doctor about which medicines will not disrupt your sleep.

Cognitive behavioral therapy for insomnia (CBT-I)

CBT-I is a 6- to 8-week detailed treatment plan to help you learn how to fall asleep faster and stay asleep longer. This is usually recommended as the first treatment option for long-term insomnia and can be very effective if done properly. CBT-I can be done in person by a doctor, nurse, or therapist; by telephone; or online. It involves the following parts: 

  • Cognitive therapy to feel less nervous about sleep and have more positive thinking.
  • Relaxation or meditation therapy to teach you how to relax and fall asleep faster.
  • Sleep education to help you learn good sleep habits.
  • Sleep restriction therapy, which gives you a specific amount of time to spend in bed, whether or not you are able to sleep during this time. With time, this helps you sleep better when you go to bed. Your sleep time can be increased when you start to sleep better.
  • Stimulus control therapy to help you have a regular sleep-wake cycle and link being in bed with being asleep. This involves going to bed only when you are sleepy, getting out of bed if you cannot sleep, and using your bed only for sleep and sexual activity.

Medicines

Prescription medicines

Many prescription medicines are used to treat insomnia. Some are meant for short-term use while others are meant for longer-term use. Some insomnia medicines can be habit-forming and all of these medicines may cause dizziness, drowsiness, or worsening of depression or suicidal thoughts. All of the medicines listed below may cause insomnia. Talk to your doctor about the benefits and side effects of insomnia medicines.

  • Benzodiazepines, which can be habit-forming and should be taken for only a few weeks.
  • Benzodiazepine receptors agonists, such as zolpidem, zaleplon, and eszopiclone. Additional side effects may include anxiety. Rare side effects may include a severe allergic reaction or unintentionally doing activities while asleep such as walking, eating, or driving.
  • Melatonin receptor agonists, such as ramelteon. Rare side effects may include doing activities while asleep such as walking, eating or driving or a severe allergic reaction. 
  • Orexin receptor antagonists, such as suvorexant. This medicine is not recommended for people who have narcolepsy. Rare side effects may include doing activities while asleep such as walking, eating, or driving or not being able to move or speak for several minutes while going to sleep or waking up.

Off-label medicines

In some special cases healthcare providers may prescribe medicines that are commonly used for other health conditions but are not yet approved by the FDA to treat insomnia. Some of these medicines may include antidepressants, antipsychotics, and anticonvulsants.

Over-the-counter medicines and supplements

Some over-the-counter (OTC) products that contain antihistamines are sold as sleep aids. Although these products might make you sleepy, talk to your doctor before taking them. Antihistamines can be unsafe for some people. Also, these products may not be the best treatment for your insomnia. Your doctor can advise you whether these products will help you.

Melatonin supplements are lab-made versions of the sleep hormone melatonin. Many people take melatonin supplements to improve their sleep. However, research has not proven that melatonin is an effective treatment for insomnia. Talk to your doctor before using these supplements. Dietary supplements can be beneficial to your health, but they can also have health risks.

The U.S. Food and Drug Administration regulates dietary supplements under a different set of regulations than those covering "conventional" foods and medicines. It does not have the authority to review dietary supplement products for safety and effectiveness before they are marketed.

Side effects of melatonin may include daytime sleepiness, headaches, upset stomach, and worsening depression. It can also affect your body's control of blood pressure, causing high or low blood pressure.

Other medicines

Your doctor may also prescribe medicines to treat other diseases that you may have in addition to your insomnia.

Other treatments

Your doctor may recommend that you use light therapy to set and maintain your sleep-wake cycle. With this treatment, you plan time each day to sit in front of a light box, which produces bright light similar to sunlight.