Treatment and Prevention
A treatment plan for insomnia can include treating an underlying medical problem, learning about and practicing good sleep hygiene, learning about and making behavior changes, and taking sleep medications. If insomnia is caused by an underlying medical condition such as arthritis or depression, the condition should be treated first, as this will likely alleviate the insomnia.
Sleep hygiene includes basic things you can do to increase your chances of having a good night sleep. Changing certain behaviors can also help improve sleep. As part of a treatment plan, your doctor might recommend any of the following sleep hygiene or behavior changes:
- Develop a regular bedtime routine.
- Don't use the bedroom for daytime activities - just for intimacy and sleep.
- Don't consume coffee or chocolate before going to bed.
- Don't go to bed thinking about work or other stressful matters - read a book for a while if this helps reduce stress.
- Learn to replace worrying thoughts about sleep to more positive ones.
- Go to bed at the same time every night, even on weekends.
- If you have a back disorder, try lying on your back with a pillow under your knees.
- Keep the bedroom dark, quiet, and not too warm - white noise devices can help drown out traffic sounds or a partner's snoring.
- Drink warm milk or have a warm bath before bed.
- Minimize the use of medications that may affect your sleep, such as diuretics and appetite suppressants - if you must take them, don't take them before going to bed.
- Exercise during the day - if exercising before bed keeps you up, then exercise earlier.
- Avoid eating a large meal before bedtime.
- Try to cut down on smoking and alcohol, especially in the evening.
- Avoid watching the clock - just set the alarm and turn the clock around so you can't see the time.
- Use relaxation techniques.
Your doctor may also prescribe a sleep medication, especially if your insomnia is caused by acute stress (e.g., loss of a loved one) or if non-medication approaches haven't helped. These medications can help in the short-term (e.g., for a few weeks), but they are not a cure and may even worsen insomnia if used for long periods of time. This happens when sleeping medications are stopped and the insomnia comes back even worse than before.
Benzodiazepines (e.g., flurazepam*, nitrazepam, temazepam, triazolam) are commonly used medications for insomnia. There are several benzodiazepines that can be used, although some have been studied more than others. Your doctor will consider your age, other medical conditions, and side effects of the benzodiazepine when selecting the one that is best for you. For some people benzodiazepines can cause physical dependence, which can cause withdrawal symptoms when stopped.
Benzodiazepines can also lead to tolerance (a reduced effect over time). For this reason doctors don't like to prescribe them for long periods (no more than 21 consecutive days), unless other treatments fail or it is clear that tolerance is not developing. Another medication use to treat insomnia is called zopiclone, which is not a benzodiazepine.
If you are prescribed a medication to help with sleep, it's important to continue to use non-medication approaches as well.
If odd working hours disturb your sleep rhythm, the best way to get back on track is to expose yourself to bright sunshine in the morning. The evidence shows that this resets the body clock more effectively than the much-hyped hormonal medication melatonin. Natural light causes the brain to produce melatonin anyway. Melatonin supplementation hasn't been adequately researched and may have adverse effects of which we are unaware at this time.
L-tryptophan is another supplement that may be helpful for insomnia, but its affects are not as predictable as other medications.
Non-prescription medications that contain diphenhydramine are available. If you find that you have sleep problems, it is best to see you doctor for a proper assessment.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.