Many people will be able to resolve their insomnia by improving their sleep habits. Also, your healthcare provider can help you find behavioral programs designed to alleviate insomnia, or may prescribe one of the several kinds of medications available to treat insomnia. While medications are often very helpful in the short term, they may not work as well in the long term. Some studies have found that behavioral therapy provides longer-lasting relief.
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Several behavioral therapies are available to help you with your insomnia. They may be used in combination with each other and/or with medications. Many of these therapies are aimed at strengthening associations between the bed and sleep and decreasing the amount of time spent lying in bed worrying about not sleeping, which, of course, only makes sleep more elusive. Behavioral therapies include:
Stimulus control therapy helps to strengthen the connection between the bedroom and sleeping by following such strategies as using the bedroom only for sleeping and sexual activity. In this type of therapy you will learn that activities like eating, working, paying bills, arguing, and watching television should not be pursued in bed. You'll also learn to get into bed only when sleepy. And if you are unable to sleep after 15 to 20 minutes, you should leave the bedroom and to do something restful, such as reading with a dim light.
Temporal control therapy promotes the routine of the sleep-wake schedule. In this type of therapy you'll learn strategies like avoiding daytime naps as well as getting out of bed at the same time each day, including weekends and holidays, no matter how well or how long you slept the night before.
Sleep restriction therapy seeks to increase the quality of sleep by limiting time spent in bed to sleeping only. In this therapy, you and the therapist will devise a strategy for not spending too much time in bed awake. For example, if you spend 6 hours asleep every night, you can limit yourself to 6 to 6.5 hours per night in bed. This creates some mild sleep deprivation, which is expected to increase your chance to sleep the next night. Your time in bed is increased gradually by going to bed earlier until you are sleeping the amount of time that leaves you feeling rested.
Cognitive behavioral therapy focuses on exploring beliefs and assumptions about sleep and changing mistaken beliefs that contribute to insomnia. It also is helpful in whittling down overblown fears about your insomnia. An example of such a fear: If you don't fall asleep soon, you'll be so tired tomorrow that you'll lose your job. Cognitive behavioral therapy may be particularly helpful for people who have chronic insomnia.
Relaxation techniques and meditation This section has more on relaxation techniques and meditation, which can help reduce any stress that is causing your insomnia or making it worse.
The following strategies and techniques have helped many people with insomnia.
Progressive muscle relaxation
Exercises that tense, then relax each muscle group can help the body prepare for sleep. As you lie in bed, tense the muscles in each area of your body and relax them, one area at a time. Start with your legs, then your buttocks and thighs, and so on up your body until every part of you has had the chance to relax.
In guided imagery, you imagine yourself in your favorite peaceful place—maybe a porch swing at a beloved house or on a beach in the later afternoon when the crowds are gone. You close your eyes and imagine the sights, sounds, and smells of the place. This can help you relax and, if you continue imagining the same place over the course of weeks, doing so can become part of a routine that your mind associates with sleep.
This can be done by itself or as part of any relaxation technique. Breathe deeply, but instead of lifting your chest and shoulders, breathe down into your abdomen. Breathe in slowly, hold the breath for a second or two, and relax to let the air escape. Repeat.
In biofeedback, a technician places sensors on your skin, connected to machines that display information about brain waves, skin temperature, and other physiological aspects of the stress response. Through biofeedback training, you may be able to learn to recognize and control your stress response.
In meditation, you learn to concentrate without allowing the mind to wander. Quieting your mind has been shown to decrease stress.
The drugs most often prescribed for insomnia are benzodiazepines and related drugs (such as Halcion and Ambien) and antidepressants such as trazodone (Desyrel, Sideril, and Trazonil).
While most drugs sedate the brain as a whole, the new drug ramelteon (Rozerem) works by targeting the part of the brain responsible for keeping you awake. This drug is thought to be more helpful for people who have trouble falling asleep than for those who wake up often at night or wake up too early in the morning.
Barbiturates (Nembutol, Seconal) were often prescribed for insomnia before benzodiazepines were introduced but they now are rarely prescribed because they are addictive and it is relatively easy to overdose on them.
In addition to the drugs listed above, some doctors may prescribe other medications with sedating effects, such as some antipsychotics.
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Medicines such as Halcion, Restoril, Ambien, Lunesta, and Sonata are often used to treat insomnia. Although these medicines work in slightly different ways, they all work on the same set of receptors in the brain to induce sedation. These drugs are helpful for short-term sleep problems caused by jet lag or acute stress. They are often prescribed for people with chronic insomnia, too. Most sleep medicines are classified as controlled substances because of the potential for abuse, although this risk is thought to be lower with the newer medicines.
Different medicines stay in the body for different amounts of time. Short-acting medicines (such as Sonata) are used for people who have trouble falling asleep. For people who can't fall asleep quickly and wake up often, intermediate-acting medicines (such as Ambien) may be helpful. People who wake up too early may be helped by a long-acting medicine (such as Lunesta), or they may take a short-acting medicine when they awake to help them go back to sleep.
People taking sedating medicines should keep in mind that they cause side effects:
- Long-acting medicines may cause sleepiness the next day. This may be more noticeable among the elderly. Accidents and falls due to grogginess may injure the elderly.
- Caution should be used when operating motor vehicles or doing other tasks that require alertness.
- Insomnia may develop again if medicines are stopped quickly. Talk to your doctor before you stop taking a medicine.
- Tolerance to the medicine may develop with long-term use.
- Pregnant women and breast-feeding mothers should avoid these medicines.
- Doses may need to be changed in people with liver or kidney problems.
- These medicines may suppress breathing and so may not be appropriate for those with sleep apnea or a chronic lung disorder.
Depression and insomnia are often linked. Indeed, insomnia is a common symptom of depression, often the first to appear.
Many older antidepressants have the side effect of drowsiness. While this can be a problem for people taking the drugs for depression, it can be an asset for people with insomnia, even those who are not depressed. Further, those who are depressed may find that these antidepressants improve their mood as well as their sleep. Antidepressants are not approved by the Food and Drug Administration for the treatment of insomnia, but doctors may prescribe these drugs for insomnia anyway.
The older antidepressant trazodone is one of the most commonly prescribed medications for insomnia. The dose prescribed for insomnia is lower than that prescribed for depression. Because of side effects at higher doses, trazodone is now rarely prescribed for depression alone.
People taking trazodone should consider:
- The sedating effect may last into the next day. This may be more noticeable among the elderly. Accidents and falls due to grogginess may injure the elderly.
- Possible side effects include confusion, fainting, muscle tremors, heart arrhythmias, and a dry mouth.
- Caution must be used when operating motor vehicles or doing other tasks that require alertness.
- Trazodone is secreted in breast milk. Tell your doctor if you are pregnant, breastfeeding, or planning to get pregnant.
Some tricyclic antidepressants, including doxepin and amitriptyline, are sometimes prescribed for insomnia.
The antidepressants known as selective serotonin reuptake inhibitors (SSRIs), such as Zoloft and Prozac, may have insomnia as a side effect, so they aren't prescribed to treat insomnia. However, if insomnia is caused by depression, treating the depression with SSRIs may improve the patient's sleep.
Over-the-counter medications for insomnia rely on antihistamines to sedate the brain. These should be avoided because they can cause grogginess the next day, as well as constipation, confusion, and even delirium, especially in older people.
Many people try to treat their insomnia with alcohol. It is true that alcohol helps you fall asleep, but it interferes with sleep later in the night, so drinking actually makes sleep worse overall.
Several dietary supplements, including melatonin and valerian root, are said to help sleep, but there is little evidence to support the claims. Unlike with drugs, manufacturers of dietary supplements are not required to prove that their products are safe or effective before marketing them.
Last reviewed on 06/26/2006
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