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Treatments and drugs
By Mayo Clinic staffChanging your sleep habits and addressing any underlying causes of insomnia can restore restful sleep for many people. Good sleep hygiene — simple steps such as keeping the same bedtime and arising time — promotes sound sleep and daytime alertness. If these measures don't work, your doctor may recommend medications to help with relaxation and sleep.
Behavior therapies
Behavioral treatments teach you new sleep behaviors and ways to improve your sleeping environment. Behavior therapies are equally or more effective than are sleep medications. Behavior therapies are generally recommended as the first line of treatment for people with insomnia.
Behavior therapies include:
- Education about good sleeping habits. Sleep hygiene teaches habits that promote good sleep.
- Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. These strategies help you control your breathing, heart rate, muscle tension and mood.
- Cognitive behavioral therapy. This involves replacing worries about not sleeping with positive thoughts. Cognitive behavioral therapy can be taught through one-on-one counseling or in group sessions.
- 'Stimulus control.' This means limiting the time you spend awake in bed and associating your bed and bedroom only with sleep and sex.
- Sleep restriction. This treatment decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.
- Light therapy. If you fall asleep too early and then awaken too early, you can use light to push back your internal clock. During times of the year when it's light outside in the evenings, you go outside or get light via a medical-grade light box.
Medications
Taking prescription sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem), also may help you get to sleep. However, in rare cases, these medications may cause severe allergic reactions, facial swelling and unusual behaviors, such as driving or preparing and eating food while asleep. Side effects of prescription sleeping medications are often more pronounced in older people and may include excessive drowsiness, impaired thinking, night wandering, agitation and balance problems.
Doctors generally don't recommend relying on prescription sleeping pills for more than a few weeks, but several newer medications are approved for indefinite use. However, some of these medications are habit-forming.
If you have depression as well as insomnia, your doctor may prescribe an antidepressant with a sedative effect, such as trazodone, doxepin or mirtazapine (Remeron).
Over-the-counter sleep aids
Sleep medications available over-the-counter contain antihistamines that can make you drowsy. But antihistamines may reduce the quality of your sleep, and they can cause side effects, such as daytime sleepiness, dry mouth and blurred vision. These effects may be worse in the elderly.
- Insomnia. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/inso/inso_all.html. Accessed Oct. 7, 2010.
- Approach to the patient with a sleep or wakefulness disorder. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec16/ch215/ch215b.html. Accessed Oct. 7, 2010.
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- Owens JA, et al. Impact of delaying school start time on adolescent sleep, mood, and behavior. Archives of Pediatric and Adolescent Medicine. 2010;164:608.
- Natural medicines in the clinical management of insomnia. National Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed Oct. 8, 2010.
- Cao H, et al. Acupuncture for treatment of insomnia: A systematic review of randomized controlled trials. The Journal of Alternative and Complementary Medicine. 2009;15:1171.
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