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Treatments and drugs

By Mayo Clinic staff

Changing 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 rising 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 make your sleeping environment more conducive to sleep. Studies have shown 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 therapy. This involves replacing worries about not sleeping with positive thoughts. Cognitive 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 for 30 minutes or obtain 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.

If you have depression as well as insomnia, your doctor may prescribe an antidepressant with a sedative effect, such as trazodone (Desyrel), doxepin (Sinequan, Adapin) or mirtazapine (Remeron).

Over-the-counter sleep aids contain antihistamines that can induce drowsiness. But antihistamines may reduce the quality of your sleep, and they can cause side effects such as daytime sleepiness, dry mouth and blurred vision.

Lifestyle and home remedies Tests and diagnosis
References
  1. Bonnet MH, et al. Overview of insomnia. http://www.uptodate.com/home/index.html. Accessed Dec. 15, 2008.
  2. Insomnia. National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/inso/inso_all.html. Accessed Dec. 15, 2008.
  3. Wilson JF. In the clinic: Insomnia. Annals of Internal Medicine. 2008;ITC1.
  4. Wolkove N, et al. Sleep and aging: 1. Sleep disorders commonly found in older people. Canadian Medical Association Journal. 2007;176:1299.
  5. Ramakrishnan K., et al. Treatment options for insomnia. American Family Physician. 2007;76:517.
  6. In brief: Your guide to healthy sleep. National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/health/public/sleep/healthysleepfs.pdf. Accessed Dec. 15, 2008.
  7. Cole C, et al. Sleep disruption in older adults. American Journal of Nursing. 2007;107:40.
  8. Insomnia. National Women's Health Information Center. http://www.womenshealth.gov/faq/Insomnia.cfm. Accessed Dec. 15, 2008.
  9. Your Guide to Healthy Sleep. National Heart Lung and Blood Institute. www.nhlbi.nih.gov/health/public/sleep/healthy_sleep.pdf. Accessed Dec. 15, 2008.
  10. Bonnet MH, et al. Types of insomnia. http://www.uptodate.com/home/index.html. Accessed Dec. 15, 2008.
  11. Bonnet MH, et al. Diagnostic evaluation of insomnia. http://www.uptodate.com/home/index.html. Accessed Dec. 15, 2008.
  12. Whitworth JD, et al. Which nondrug alternatives can help with insomnia? The Journal of Family Practice. 2007;56:836.
  13. Lamberg L. Despite effectiveness, behavioral therapy for chronic insomnia still underused. JAMA: The journal of the American Medical Association. 2008;300:2474.
  14. Bonnet MH, et al. Patient information: Insomnia treatments. http://www.uptodate.com/home/index.html. Accessed Dec. 15, 2008.
  15. Bonnet MH, et al. Treatment of insomnia: Pharmacologic therapy. http://www.uptodate.com/home/index.html. Accessed Dec. 15, 2008.
  16. Wolkove N, et al. Sleep and aging: 2. Management of sleep disorders in older people. Canadian Medical Association Journal. 2007;176:1449.
  17. Bonnet MH, et al. Treatment of insomnia: Nonpharmacologic therapy. http://www.uptodate.com/home/index.html. Accessed Dec. 15, 2008.

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Jan. 8, 2009

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