Insomnia

Treatment

After underlying conditions are ruled out or addressed, treatment for insomnia usually consists of cognitive behavior therapy (CBT) and, in some cases, medication.

CBT is generally the preferred treatment as it has a better long-term success rate and lacks the potential side effects of medications, which are not designed for long-term use.

Cognitive Behavior Therapy

Cognitive behavior therapy helps patients change thoughts and behaviors that interfere with sleep. Treatment methods are often used in combination for increased effect. Some of the most common methods include:

Stimulus control
Aims to create a positive response (sleep) to the sleep environment. Some strategies include:

• Going to bed only when sleepy
  
• Using the bedroom only for sleeping and sexual intimacy (as opposed to reading, writing, studying, watching TV, or other activities)
  
• Going to another room when unable to sleep and engaging in another activity until sleepy

Sleep restriction
Limits the time allotted for sleep at night in order to increase the ratio of time spent actually sleeping to time spent in bed. Begins with short sleep times that gradually increase as a stable sleep pattern emerges.

Relaxation training
Aims to reduce tension and anxiety and may include physical and mental components such as:

• Progressive muscle relaxation
  
• Biofeedback
  
• Imagery training
  
• Meditation
  
• Hynopsis

Cognitive control
Reveals and alters false or negative beliefs and attitudes about sleep — for example, that eight hours is required for health.

Sleep hygiene education
Corrects external factors affecting sleep such as:

• Snoring (by bed partners)
  
• Bedroom temperature
  
• Fixation on the bedside clock
  
• Use of alcohol, nicotine or caffeine
  
• Exercise: lack of or too close to bedtime

Medication

For some patients who do not benefit from CBT, or as a short-term adjunct therapy, medications might be prescribed. Types include:

• Nonbenzodiazepine hypnotic medications (newer class of sleeping pills)
  
• Benzodiazepine hypnotic medications (older class of sleeping pills)
  
• Melatonin-receptor agonists