Insomnia

Treatment Overview

Insomnia is often a symptom of another condition rather than a condition of its own. If insomnia is caused by medical or psychological conditions, treatment for insomnia will focus on those other conditions. When poor sleep quality itself is the major problem, medicines can be prescribed short-term to relieve symptoms.

There is increasing support for therapies that involve modifying behaviour and lifestyle. These two approaches—medicine and behaviour therapies—may be used together, with medicine helping to provide a good night's sleep in the short term and behaviour therapy helping you develop long-lasting changes in approaches to sleep.

• Work with your doctor to try first to find out whether another condition—such as depression, anxiety, pain, use of stimulants or medicines, inactivity, or poor sleep habits—is causing your insomnia, and then to treat that cause.
• You may be able to treat your insomnia with minor lifestyle changes, such as changing your sleep environment or schedule, increasing your activity level, or changing what and when you eat and drink.
• Sleep-inducing medicines can be used if other types of treatment don't work. But medicine should only be used intermittently, and it is not considered the first treatment of choice for long-term insomnia.

  Should I take sleeping pills for insomnia?

Behaviour therapy

Getting ready for bed means more than turning down the sheets. Sleep therapists know that there are many factors involved in a person's ability to sleep well. Here are examples of therapies that help you develop habits and beliefs that will promote good sleep quality.

• Relaxation therapy may be successful for people with poor sleep habits who lie in bed with their minds racing. This therapy teaches progressive muscle relaxation, in which different muscle groups are tensed and relaxed, as well as attention-focusing techniques such as meditation, which can help stop sleep-disturbing habits.
• Cognitive-behavioural therapy helps you to recognize certain beliefs you hold about yourself and sleep, to change those beliefs that may contribute to unhealthy patterns, and to introduce positive behaviours that will help you create an inviting environment for sleep. Studies of cognitive-behavioural therapy's effect on people with insomnia have shown good, lasting results in reducing interrupted sleep.⁸
• Sleep hygiene measures are simple actions that address sleep habits and factors that may keep you from good sleep. For example, keep regular bedtimes and wake times—7 days a week—and try to avoid taking naps during the day. For more information, see:

  How to set up a healthy sleep environment.

• Stimulus-control therapy re-establishes the bed as a place for sleeping and sex only—not for sleeplessness. For example, if you can't fall asleep in 15 minutes, you get out of bed and do something quiet and relaxing until you are sleepy again.
• Sleep-restriction therapy limits the time spent in bed to time spent sleeping.

Medications

Sleep medicines may provide rapid relief of the symptoms of insomnia. But many of these medicines have side effects, such as low blood pressure, anxiety, and nausea. These medicines also may become less effective when your body gets used to them (tolerance) and may cause withdrawal effects when you stop using them. And some have not been shown to be effective for long-term treatment of insomnia.⁹

• Hypnotic medications help you fall asleep or stay asleep.
• Antidepressants that have a calming or sedative effect can be used to aid sleep.
• Antihistamines, typically used for allergies, can be effective for short-term relief of sleeplessness.
• Non-prescription medications for sleep, or sleeping pills, can help but also can have side effects, such as drowsiness the next day. Over time, these medicines may not work as well as they did when first used.

If you are taking any of these medicines, it's usually best if you take them only for a short time, at the lowest effective dose, and stop taking them as soon as you can. This is true for all people, but it is particularly true for older adults, who can become dependent on sleep enhancers and sometimes experience diminished thinking capability during and after long-term sleeping medicine use.¹⁰

The most successful long-term treatment results have been achieved with behaviour therapy. Behaviour therapy results in similar improvements in both overall sleep quality and less time in getting to sleep compared to using medicines, without any side effects.³ Many people receiving such therapy benefit from the treatments and become good sleepers.¹¹ Perhaps most important, these results are maintained over time.

Complementary medicine

Other treatments for insomnia may include complementary and alternative medicines. Two of the most popular alternative medicines are:

• Valerian, a traditional herbal sleep remedy that appears to be safe and may improve sleep when taken for a week or two.¹²
• Melatonin, a hormone produced by the brain that is available as a nutritional supplement. It has also been used to treat jet lag and poor sleep due to shift work.

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Author:	Maria G. Essig, MS, ELS Ralph Poore	Last Updated: March 13, 2008
Medical Review:	Anne C. Poinier, MD - Internal Medicine Andrew Swan, MD, CCFP, FCFP - Family Medicine Jan Ulfberg, MD, PhD - Sleep Disorders
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