What are the Best Treatment Options for Insomnia?
Dr. Angel Rivera
Insomnia is a sleep disorder that can make it difficult to fall asleep, stay asleep, or get the right amount of sleep.
When you have insomnia, it can cause daytime fatigue, problems with attention and concentration, and mood swings which can all affect your quality of life.
It can also increase the risk of other health problems such as heart disease and obesity.
If you are experiencing insomnia symptoms, it is important to see your doctor for diagnosis and treatment.
In this article, we will discuss the different treatment options available for insomnia and give you some tips on ways to prevent it.
There are different types of insomnia, but the most common form is difficulty falling asleep, staying asleep, or waking up too early.
You may suffer from acute insomnia (short-term insomnia) or chronic insomnia (long-term insomnia).
There is also primary insomnia, meaning it is not caused by another health condition, or secondary insomnia, meaning it is brought on by another health condition.
Acute insomnia can last anywhere from a day to a few weeks while chronic insomnia is defined as having sleep difficulties three days a week or more for over three months.
If you are a woman or elderly you are more likely to suffer from insomnia although it is estimated to affect 10%-30% of adults.
If you are a healthy adult you are supposed to get seven to nine hours of undisturbed sleep per night while insomniacs typically get far less or their sleep is often interrupted which makes for poor sleep quality.
The most common symptom is daytime sleepiness or feeling tired when you are awake. Other common side effects of insomnia include:
- Difficulty falling asleep
- Difficulty staying asleep
- Waking up too early and not being able to fall back asleep
- Difficulty concentrating
- Mood swings
- Increased blood pressure
- Impaired memory
- Being more prone to accidents or errors
- Malaise or lack of motivation
If you have these adverse effects and think you may have insomnia please consult with your doctor or health care provider.
There are many different things that can cause insomnia and oftentimes it is a combination of several different factors. Some common causes of insomnia include:
- Mental disorders such as anxiety, depression, and post-traumatic stress disorder (PTSD)
- Travel or work schedule altering your circadian rhythm
- Bad sleep habits such as taking naps, doing stimulating activities before bed, watching TV, or using your phone or laptop while in bed
- Chronic pain such as arthritis or fibromyalgia (widespread pain)
- Restless legs syndrome
- Eating a big meal before bedtime
- Drinking too much liquid before bedtime
- Medications such as antidepressants, asthma medications, or blood pressure medications can keep you more alert and not want to sleep
- Medical conditions such as obstructive sleep apnea, cancer, overactive thyroid, Parkinson's disease, Alzheimer's disease, and gastroesophageal reflux disease (GERD) to name a few
- Stressful life events such as the death of a loved one, job loss, divorce, or concerns about finances
- Fluctuations in your hormones such as those caused by menopause or menstruation
- Living an unhealthy lifestyle
- Using nicotine, alcohol, or caffeine before bed
If you are a woman you are more likely to experience insomnia due to hormonal changes throughout your life.
Also, if you are over 60 years old you are more likely to experience insomnia due to changes in your health, changes in your sleep pattern as you age, lower physical activity levels, and taking more medications.
Your doctor will start by asking you questions about your sleep habits and will also ask about your medical history including any medical conditions or medications that might be affecting your sleep.
They may also conduct a physical exam to look for any other underlying causes of insomnia.
Keeping a sleep diary for at least a couple of weeks before seeing your doctor may be a good idea so your doctor can know the details of your condition.
In some cases, a sleep study (polysomnography) may be ordered to rule out other sleep disorders and assess how well you are sleeping.
The sleep tests can be conducted at a sleep lab while being monitored by a sleep specialist or there are now at-home sleep test kits that you can perform yourself from the comfort of your own home and then send the results to a lab for analysis.
There are a number of different insomnia treatments available and the best one for you will depend on the underlying cause of your insomnia as well as your own preferences and health status.
Some common treatments of insomnia include:
Cognitive behavioral therapy
Cognitive behavioral therapy for insomnia (CBT-I) is a nonpharmacologic treatment (meaning it does not use drugs to induce sleep) and is a type of therapy that focuses on changing the negative thoughts and beliefs about sleep that may be contributing to your insomnia.
CBT-I has been shown to be an effective treatment of insomnia and can often provide long-lasting relief from sleep difficulties.
There are several forms of cognitive therapy for the management of insomnia and these include:
- Stimulus control therapy where you learn to associate your time in bed with only sleep and sex and not with activities such as watching TV or working on the computer and also involves going to bed only when you are sleepy and getting out of bed if you can’t fall asleep within 20 minutes
- Sleep restriction therapy where you restrict the amount of time you spend in bed while avoiding naps, and these reductions in sleep will eventually leave you tired enough to start sleeping through the whole night
- Relaxation techniques include progressive muscle relaxation, biofeedback, meditation, and breathing exercises to help relax you before bedtime
- Remaining passively awake involves going to your bed intending to stay awake to relieve the worry and anxiety of having to try to sleep
- Light therapy where you expose yourself to bright light in the morning which can help to adjust your body’s natural sleep-wake cycle
Besides behavioral treatment methods, there are also a number of different medications that can be used for the treatment of sleep disorders including insomnia.
These sleep aids approved by the U.S. Food and Drug Administration (FDA) include:
Also called BZDs, benzodiazepines are a type of sedative that can be used to treat insomnia.
These drugs are effective in helping you fall asleep and may cause side effects such as drowsiness, dizziness, and impaired coordination.
It needs to be noted that benzodiazepine therapies can be habit-forming and have the potential for abuse.
Also called Z-drugs, non-benzodiazepines are a type of sedative that can also be used to treat insomnia.
These drugs are typically not as addictive as benzodiazepines.
These are medications that are used to treat other conditions but can have a side effect of helping to treat insomnia.
Most often these are antipsychotic or antidepressant medications.
Melatonin receptor agonists
Melatonin receptor agonists act on the same receptors as melatonin, a hormone that is made in the pineal gland of your brain that induces sleepiness.
Orexin receptor agonists
Orexin is a neurotransmitter that helps to make you feel tired or awake. Orexin receptor agonists work by binding to the orexin receptors in your brain and helping to promote sleepiness.
The most common over-the-counter medications that can be used to treat insomnia are antihistamines.
These drugs work by blocking histamine receptors which can help to induce sleepiness.
Melatonin therapies such as melatonin supplements are also available although it is advised that you consult your doctor before starting any new medication or supplement.
What are the complications caused by insomnia?
If insomnia is not treated, it can lead to a number of complications including:
- Increased risk of motor vehicle accidents and an increased risk of falls
- Performance issues at work or school
- High blood pressure (hypertension)
- Mental health conditions such as depression and anxiety
- Substance abuse such as alcohol dependence
- Heart disease
- Obesity and weight gain
Insomnia can also negatively impact your quality of life and make it difficult to function during the day which makes it important that you discuss this condition with your doctor or health care provider.
There are a number of things that you can do to help prevent insomnia or make it less likely to occur. These include:
- Establishing and maintaining a regular sleep time even on weekends to encourage improvements in sleep onset
- Avoiding caffeine, nicotine, and alcohol before bedtime
- Exercising regularly but not close to bedtime can help with insomnia and has numerous other health benefits
- Creating a relaxing bedtime routine that can include a warm bath, reading, meditation, or listening to soothing music as examples
- Using your bed for sex and sleeping only and not watching TV or using your phone or laptop while in bed
- Talking to your doctor about any supplements or medications you are currently taking to make sure they are not causing you difficulty sleeping
- Avoid naps if possible
- Do not eat large meals before bedtime
- Create a bedroom environment that is conducive to sleep (comfortable mattress, curtains to block out sunlight, wearing a mask if necessary, etc.)
If you are having difficulty sleeping, it is important to talk to your doctor so they can help determine the cause and recommend the best treatment options for you.
Treatment options can vary from cognitive behavioral therapy to medications and there are also things you can do to help prevent it that we listed above.
Insomnia can have a number of complications if it goes untreated which makes it important to start treatment as soon as possible.
If you have any more questions regarding your quality of sleep, insomnia, or treatment options, please talk to your doctor or health care provider.
References, Studies and sources:
- Insomnia Diagnosis
- Insomnia Overview
- Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills