Understanding Insomnia -- Treatment

What Is the Treatment for Insomnia?

Treatment for insomnia may involve nonmedical therapy, such as developing better sleep habits or psychotherapy, and sometimes medications. If a medical condition like diabetes or menopause is causing your insomnia, treating those conditions may help. If insomnia is a side effect of a medication, changing the medication or its timing or reducing the dose may help. Always talk to your health care provider before making changes to any medications you are taking.

Short-term insomnia, often caused by travel or stress, usually improves once the stress is removed or after your body has adjusted to the new schedule. Short-term use of over-the-counter sleep remedies may help. Chronic insomnia, which disrupts sleep for extended periods of time, may call for a thorough physical exam, alteration of some lifestyle habits, medical treatment, and, perhaps, psychotherapy to identify a hidden cause. It is most important to treat any problem that is producing insomnia symptoms. Just treating insomnia symptoms without dealing with the main cause will not be helpful.

Sleep Medications

Benzodiazepine sedatives such as triazolam (Halcion), estazolam, lorazepam (Ativan), temazepam (Restoril), flurazepam, and quazepam (Doral) and non-benzodiazepine sedatives such as zolpidem (Ambien, Intermezzo), eszopiclone (Lunesta), and zaleplon (Sonata) are drugs that can help induce sleep. However, these medicines may be addictive with extended use. Also they can be dangerous if you take them with alcohol or other drugs that depress the central nervous system. They can cause morning sleepiness, although side effects are generally less severe with the non-benzodiazepines. A prescription oral spray called Zolpimist, which contains Ambien's active ingredient, can be used for short-term treatment of insomnia.

Belsomra (suvorexant) is the first approved orexin receptor antagonist. Orexins are chemicals that are involved in regulating the sleep-wake cycle and play a role in keeping people awake. Belsomra alters the action of orexin in the brain.

Doxepin (Silenor) is approved for treating people who have trouble staying asleep. Silenor may help with sleep maintenance by blocking histamine receptors. Do not take this drug unless you are able to get a full seven or eight hours of sleep. Dosage is based on your medical condition, age, and response to therapy.

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Antidepressant drugs may be used in people with depression to help with sleep. They are not approved for the treatment of insomnia. These may cause daytime sleepiness or other side effects.

Ramelteon (Rozerem) is an insomnia medication that works differently than the other sedative medications. It is less likely to cause morning sleepiness or to be addictive.

Over-the-counter sleep drugs usually contain an antihistamine. Antihistamines are often used for allergies, but they have a side effect of drowsiness. These medications may cause daytime sleepiness and dry mouth along with other side effects.

Relaxation

Many poor sleepers simply need help relaxing. If you're a habitual insomniac and trying to get to sleep just makes you more anxious and awake, try these alternative choices to help reduce your worry about sleep while relaxing your body and mind. If the root cause of insomnia is stress, any treatment must address the problem of stress in your life.

Breathing exercises can promote relaxation. Here's a routine you can do anywhere, anytime:

  1. Exhale completely through your mouth.
  2. Inhale through your nose to a count of four.
  3. Hold your breath for a count of seven.
  4. Exhale through your mouth for a count of eight.
  5. Repeat the cycle three times.

Exercise

Moderate exercise can help you sleep better and give you more energy while awake. Aim for a 20- to 30-minute routine three or four times a week. Tailor the workout to your physical condition, and exercise in the morning or afternoon, not close to bedtime. Check with your doctor about how much and what type of exercise is right for you.

Mind/Body Medicine

Meditation, yoga, and biofeedback may reduce tension and promote better sleep. Visualization or guided imagery, during which you hold a peaceful image in your mind before bedtime, can also be an effective path to relaxation. You can learn these techniques from an instructor, online sites, a how-to book, or an instructional tape.

Good Sleep Habits

Be sure your bedroom is quiet and dark. Eye shades may help since light comes in even through closed eyelids.

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Both children and adults may have trouble sleeping if they are overstimulated by activity or watching television just before bedtime. A quarter hour of quiet conversation, light reading, or soft music before going to sleep may make all the difference. Also, these steps are important:

  • Try to keep a regular sleep schedule.
  • Avoid heavy meals, smoking, alcohol, or caffeine near bedtime.
  • Keep the bedroom reserved for sleep and sex only.

If you wake up at night and can't go back to sleep, remain quiet and relaxed. Even normal sleep can be punctuated by periods of restlessness or even waking. Be patient; sleep usually returns. Remember, a few nights of poor sleep do no long-term harm. Even if you toss and turn trying to get to sleep, you are probably getting more periods of sleep than you think.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on March 22, 2015

Sources

SOURCES: 

U.S. Department of Health and Human Services. 

National Heart, Lung and Blood Institute. 

American Academy of Family Physicians. 

WebMD Medical Reference: "Insomnia" and "Sleep Disorders: Insomnia." 

WebMD Health News: "Oral Spray Sleep Drug Zolpimist Approved." 

FDA: "Silenor Medication Guide."

News release, FDA.

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