What to Do About Insomnia

Can't Sleep? Insomnia Types, Causes, and Treatments

From the WebMD Archives


Back to Sleep

Developing good sleep hygiene is very important for insomnia relief. For example, smoking, drinking, and exercise can affect your sleep dramatically. What you actually do in bed (like reading or watching TV), the temperature of room, noise levels, the timing and amount of fluids you drink, and the food you eat significantly impact insomnia. Exposure to light in the evening (looking at a bright computer screen, turning on the light to go to the bathroom) may alter your circadian rhythms. Poor hygiene alone can generate significant sleep problems.

Treatment for insomnia falls into two basic categories, medication and behavioral strategies for sleep initiation. Doctors tend to use one of three different types of medication for insomnia, including:

  1. The so-called non-benzodiazepine or "non-valium-like" hypnotics (such as Ambien and Sonata) are designed for insomnia and are often first-line treatment. They are especially effective because they work quickly, do not disrupt your "sleep architecture" or the quality of your sleep.
  2. When considering underlying depression associated with insomnia, antidepressants are often used because of their sedating side effects.
  3. Hypnotics (including Restoril, Halcion, and Klonopin) should be used only in selected patients because they are potent medications that greatly impact the quality of sleep and may have severe side effects, including daytime drowsiness and addiction.

Behavioral strategies include:

  1. Sleep restriction, that is, restricting where one sleeps to only the bed. The idea here is that you sleep only in bed and you stay in bed only when asleep. Do not lie awake in bed for hours on end. If you do not fall asleep after about 25 minutes, get out of bed and do something calming, like read a book. This helps reduce the anxiety-provoking association of being awake while in bed, and ultimately may create the positive association of sleeping well in bed. When restricting sleep in this manner, you will eventually become so tired that you become sleepy earlier in the evening, relieving insomnia. Given how tired one will be when beginning this regimen, activities where safety is an issue, like driving, should be avoided.
  2. Stimulus control involves making the bedroom a place for sleep and sex only -- no TV-watching, for example. This again tries to create associations to help train your mind.
  3. Relaxation uses certain techniques to relax your mind and body, making it easier to fall asleep and stay asleep.
  4. Cognitive behavioral therapy. Here a psychologist helps to eliminate those thoughts associated with a poor night's sleep.