If you have trouble falling asleep or staying asleep, you may have insomnia, the most common sleep disorder. Between 10% and 30% of adults have chronic insomnia, and many more deal with it from time to time. Here’s a look at some of the latest research on this condition, its causes, and treatments that may help.
A new type of drug is giving doctors another option when it comes to prescription medication to treat insomnia.
Orexin receptor antagonists. Some of the latest sleep medications are known as orexin inhibitors. They block the action of a brain chemical that keeps you alert, called orexin. Two of these drugs include:
Scientists are studying two other similar drugs in clinical trials.
All sleeping pills come with risks and side effects. With some, you can develop a tolerance, which means it stops working effectively at the recommended dosage, or even feels like you can’t fall asleep without them. Some can cause you to walk, eat, or even drive in your sleep. Most can leave you feeling groggy the next day. Doctors usually only prescribe them for the short term, and you have to stop using them gradually.
Melatonin. Your body makes this hormone as the sun goes down, telling you it’s time to get sleepy. A prescription form of melatonin helps you fall asleep by acting like melatonin in your brain.
Melatonin supplements are often sold as a treatment for insomnia. But both the American Academy of Sleep Medicine (AASM) and the American Academy of Physicians don’t recommend it, saying there isn’t enough evidence it actually works.
It’s also hard to know what you’re getting when you buy supplements. A 2017 analysis of dozens of supplements found that more than 70% of the time, the amount of melatonin in the product didn’t match what was on the label.
Nondrug Insomnia Therapies
Your doctor probably won’t prescribe a sleeping pill until you’ve tried other treatments. Scientists are studying nondrug therapies that can help insomnia, but cognitive behavioral therapy is one option sleep experts often recommend first.
CBT-I. The AASM put out new guidelines in early 2021 strongly recommending cognitive behavioral therapy for insomnia (CBT-I). When you do CBT-I, you meet with a therapist to learn how to change thoughts and behaviors that may be keeping you from getting a good night’s sleep. It involves several techniques that you may try one at a time or in combination.
- Cognitive restructuring. The therapist will help you identify and change unhelpful thoughts and feelings that may be affecting your sleep, like anxiety about insomnia or unrealistic expectations.
- Stimulus control. This means setting up a sleep environment with no distractions, going to bed and getting up at the same time every day, and leaving the bedroom, rather than tossing and turning, when you can’t get to sleep.
- Sleep restriction. You’ll record the amount of time you spend sleeping with a sleep diary, then start staying in bed for only that amount of time plus 30 minutes. You’ll probably get less sleep at first. But the idea is to make yourself tired enough to get solid sleep, then gradually increase your time in bed.
- Relaxation training. Your therapist can teach you relaxation techniques like breathing exercises and meditation that may help calm your mind.
- Sleep hygiene. This includes a range of habits that promote good sleep, like getting exercise, cutting out late-night eating, alcohol and caffeine, and keeping your bedroom cool, dark, and quiet.
Therapists have traditionally provided CBT-I face-to-face. But throughout the COVID-19 pandemic, doctors have been working on alternatives to in-person sessions that appear to get good results.
Two recent studies showed that CBT-I conducted over the phone or through a video link is just as effective as face-to-face therapy. In 2020, the FDA approved an app that delivers CBT-I by prescription. Research into the app and web-based therapy programs has found that so-called digital CBT-I does help relieve insomnia.
Light therapy. Sunlight helps control your body’s sleep/wake cycle by regulating the sleep hormone melatonin. When that cycle is thrown off, artificial light that mimics sunlight can help, a practice called light therapy. You sit in front of a special box that puts out an intense light at the specific time of day and for the length of time your doctor prescribes. Research has found it’s particularly helpful with resetting your body clock if you work odd hours, like a night shift, or have jet lag. But it can also relieve insomnia.
Acupuncture. A large number of studies have looked at whether acupuncture may be an effective treatment for insomnia. Two reviews of the research published in 2021 found that acupuncture does help people sleep longer and wake up less often.
Causes of Insomnia
Other research is examining why people have insomnia and what can make it worse. Among the factors under review:
- Genetics. Scientists are looking at whether the likelihood of having insomnia is something you’re born with. They’ve identified specific areas in our genes that appear to play a role in insomnia symptoms.
- Light pollution. Korean researchers may have found a link between city lights and insomnia. A 2018 study showed that the more artificial outdoor light people were exposed to at night, the more likely they were to use sleeping medication.
- COVID-19 pandemic. An AASM survey from March of 2021 found that more than half of American adults reported sleep problems, including insomnia, since the pandemic began.
And there’s evidence the virus itself can cause you to lose sleep. A 2020 British study found 5% of people treated for COVID-19 had insomnia in the 6 months after their diagnosis.
Insomnia and Dementia
Other recent studies have looked at a possible link between insomnia and thinking and memory problems. Poor sleep could mean cognitive impairment later in life.
One 2021 study looked at people who reported having insomnia when they were younger, and then had issues with cognition years later. The people most likely to end up with thinking and memory problems were those who had sleep-onset insomnia, meaning their main symptom was trouble falling asleep. Other research published in 2020 found that people who have insomnia and sleep less than 6 hours a night had double the risk of cognitive impairment.