Insomnia is an inability to fall asleep or stay asleep long enough to feel well rested and refreshed in the morning. Insomnia is more common among women than men and is also more likely to occur with increasing age.
Insomnia can have significant negative effects on a person’s quality of life, making it difficult for them to concentrate, pay attention and function as usual during the day. Insomnia most commonly causes the following problems:
- Difficulty getting to sleep
- Waking throughout the night
- Waking up in the early hours of the morning
- Tiredness and irritability
- Difficulty functioning as usual during the day
The first treatment approach to insomnia is usually finding out whether there are any underlying causes of the problem such as a medical condition. The condition can then be treated to help alleviate the insomnia symptoms without further medical intervention being required. Other approaches doctors may take are described below.
Good sleep hygiene
A doctor will advise on the measures people can take at home to help improve their chances of a good night’s sleep. This is known of as “sleep hygiene” and doctors generally suggest trying this approach for at least three or four weeks to see if this improves symptoms. Sleep hygiene involves the following:
- Setting fixed times for going to bed and waking up. This will help to establish a regular sleeping pattern.
- Trying to relax before bedtime by having a warm bath, listening to soothing music or reading.
- Ensuring sleeping environment is comfortable in terms of temperature, noise level and light.
- Avoiding napping in the day.
- Avoiding nicotine, alcohol and caffeine late at night.
- Exercising regularly, although not for at least four hours before bed.
- Avoiding eating heavy meals or spicy foods late at night.
- Only using the bedroom for intimacy or sleeping.
- Avoiding clock checking as this can cause frustration and prevent a person getting back to sleep.
- Putting away or turning off any electrical devices with screens such as phones or televisions, as the light emitted from these can make the brain more alert.
Cognitive and behavioral treatment
If a person has long-term insomnia (insomnia for more than four weeks), a doctor may recommend cognitive and behavioral therapy. This aims to alter any unhelpful thoughts or behaviors that might be contributing to the insomnia.
Other behavioral therapies that may be recommended include:
- Stimulus-control therapy, which helps a person associate the bedroom with sleep and establish a regular sleeping pattern.
- Sleep restriction therapy, which involves a person limiting their time in bed to only when they are asleep, to create mild sleep deprivation. As sleeping improves, so does sleep time.
- Paradoxical intention, which involves staying awake and avoiding any intention of falling asleep. This only works if a person has trouble falling asleep rather than a problem with maintaining sleep.
- Relaxation training, where the aim is to reduce tension and minimise any thoughts that may be disrupting sleep.
In cases where insomnia occurs in the long-term, doctors may also consider prescribing a sleeping tablet, particularly if symptoms are severe or the above cognitive and behavioral approaches have failed to work. However, doctors are generally reluctant to prescribe these tablets because they do not address the cause of the problem and cannot help in the long-term.
If sleeping tablets are used, doctors usually prescribe the smallest effective dose for no longer than a week. Sleeping tablets can sometimes cause side effects, such as a feeling of being hungover and daytime drowsiness. Short-acting benzodiazepines or “Z medicines” are the preferred drugs for treating insomnia.
These are tranquilizers that are used to reduce anxiety and help people become calm, relaxed and sleepy. These medications can lead to dependency and only short-acting versions that have short-term effects should be prescribed. The benzodiazepine that is most commonly prescribed for insomnia is called Temazepam.
This is a newer type of short-acting drug that works in a similar way to benzodiazepines. Examples include zaleplon, zolpidem and zopiclone. Zaleplon is used to treat people who find it hard to fall asleep; zolpidem to treat debilitating insomnia or insomnia that is causing severe distress; and zopiclone to treat difficulty falling asleep, waking during the night, debilitating insomnia, or insomnia causing severe distress.
Sometimes, antidepressants are prescribed to treat insomnia, particularly in cases where an individual has a history of depression.
Medicines containing melatonin can be effective at relieving insomnia symptoms for up to 26 weeks among elderly individuals. This naturally occurring hormone helps to regulate the sleep cycle or circadian rhythm.
Sometimes, doctors consider complementary therapies such as acupuncture or homeopathy, but there is little evidence to suggest these are effective. Some herbal remedies such as passionflower and chamomile have been shown to have some positive effects in the treatment of insomnia.