January 11, 2011

Insomnia - Treatment options

How Is Insomnia Treated?

Lifestyle changes often can help relieve acute (short-term) insomnia. These changes may make it easier to fall asleep and stay asleep. 

A type of counseling called cognitive-behavioral therapy (CBT) can help relieve the anxiety linked to chronic (ongoing) insomnia. Anxiety tends to prolong insomnia. 

Several medicines also can help relieve insomnia and re-establish a regular sleep schedule. However, if your insomnia is the symptom or side effect of another problem, it's important to treat the underlying cause (if possible). Your doctor also may prescribe medicine to help treat your insomnia.

Lifestyle Changes

If you have insomnia, avoid substances that make it worse, such as:
  • Caffeine, tobacco, and other stimulants taken too close to bedtime. Their effects can last as long as 8 hours.
  • Certain over-the-counter and prescription medicines that can disrupt sleep (for example, some cold and allergy medicines). Talk to your doctor about which medicines won't disrupt your sleep.
  • Alcohol. An alcoholic drink before bedtime may make it easier for you to fall asleep. However, alcohol triggers sleep that tends to be lighter than normal. This makes it more likely that you will wake up during the night.
Try to adopt good bedtime habits that make it easier to fall asleep and stay asleep. 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.
Try to schedule your daily exercise at least 5 to 6 hours before going to bed. Don't eat heavy meals or drink a lot before bedtime.

Make your bedroom sleep-friendly. Avoid bright lighting while winding down. Try to limit possible distractions, such as a TV, computer, or pet. Make sure the temperature of your bedroom is cool and comfortable. Your bedroom also should be dark and quiet.

Go to sleep around the same time each night and wake up around the same time each morning, even on weekends. If you can, avoid night shifts, alternating schedules, or other things that may disrupt your sleep schedule.

Cognitive-Behavioral Therapy

CBT for insomnia targets the thoughts and actions that can disrupt sleep. This therapy encourages good sleep habits and uses several methods to relieve sleep anxiety. 

For example, relaxation training and biofeedback at bedtime are used to reduce anxiety. These strategies help you better control your breathing, heart rate, muscles, and mood. 

CBT also works on replacing sleep anxiety 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 time. 

CBT also may involve talking with a therapist one-on-one 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. 

CBT also focuses on limiting the time you spend in bed while awake. This method involves setting a sleep schedule. At first, you will limit your total time in bed to the typical short length of time you're usually asleep. 

This schedule may make you even more tired because some of the allotted time in bed will be taken up by problems falling asleep. However, the resulting tiredness is intended to help you get to sleep more quickly. Over time, the length of time spent in bed is increased until you get a full night of sleep.
For success with CBT, you may need to see a therapist who is skilled in this approach weekly over 2 to 3 months. CBT works as well as prescription medicine for many people who have chronic insomnia. It also may provide better long-term relief than medicine alone. 

For people who have insomnia and major depressive disorder, CBT combined with antidepression medicines has shown promise in relieving both conditions.


Prescription Medicines

Many prescription medicines are used to treat insomnia. Some are meant for short-term use, while others are meant for longer use. 

Talk to your doctor about the benefits and side effects of insomnia medicines. For instance, insomnia medicines can help you fall asleep, but some people may feel groggy in the morning after taking them. 

Rare side effects may include sleep eating, sleep walking, or driving while asleep. If you have side effects from an insomnia medicine, or if it doesn't work well, tell your doctor. He or she may prescribe a different medicine.
Some insomnia medicines may be habit forming. Talk to your doctor about the benefits and risks of insomnia medicines.

Over-the-Counter Products

Some over-the-counter (OTC) products claim to treat insomnia. These products include melatonin, L-tryptophan supplements, and valerian teas or extracts.
The Food and Drug Administration doesn't regulate “natural” products and some food supplements. Thus, the dose and purity of these products can vary. How well these products work and how safe they are isn't well understood.
Some OTC products that contain antihistamines are marketed as sleep aids. Although these products may make you sleepy, talk to your doctor before taking them. 

Antihistamines pose risks for some people. Also, these products may not offer the best treatment for your insomnia. Your doctor can advise you whether these products can benefit you.

Source: National Heart Lung and Blood Institute