Left untreated, insomnia is linked to increased illness or morbidity. There is a wealth of research indicating that people with insomnia have poorer overall health, more work absenteeism, and a higher incidence of depression. Sleep deprivation is not insomnia. It is not actually clear that insomniacs “lose sleep,” particularly when it is primary. Many do not exhibit daytime distress or symptoms. Although people with acute insomnia may experience daytime sleepiness, most chronic insomnia patients experience an unpleasant sense of excessive arousal during the daytime.
If you are experiencing difficulty sleeping, consider whether an event or particular stress could be the cause. If so, the problem may resolve in time. If not, and the problem persists for a few weeks or more, or if you experience distress and discomfort as a result of the insomnia, talk to your doctor about your symptoms. Bring with you a record of your sleep, fatigue levels throughout the day, and any other symptoms you might be having.
There are a number of approaches to treating insomnia. A health care professional will ask about your sleep experience, your sleep schedule, and your daily routine. A thorough medical history and physical examination may be called for.
Because of the close connection between behavior and insomnia, behavioral therapy is often part of any treatment for insomnia. This is because people with insomnia may begin to associate certain sleep-related stimuli with being awake. For example, bedtime routines or the bedroom itself may become linked with anxiety for a person who is experiencing insomnia because they dread the thought of another sleepless night. A combination of several behavioral treatments is typically the most effective approach. Some examples of behavioral treatments are:
- Stimulus Control Therapy: creating a sleep environment that promotes sleep
- Cognitive Therapy: learning to develop positive thoughts and beliefs about sleep
- Sleep Restriction: following a program that limits time in bed in order to get to sleep and stay asleep throughout the night
Relaxation techniques, such as yoga, meditation, and guided imagery may be especially helpful in preparing the body to sleep. Exercise, done early in the day, can also be helpful in reducing stress and promoting deeper sleep.
Behavioral therapies alone may not be enough. Treating insomnia with sleep aids is the most common treatment for these sleep problems, particularly once a combination of behavioral approaches has been tried. Sleep medications for the treatment of insomnia are called hypnotics. They should only be taken when:
- The cause of your insomnia has been evaluated
- The sleep problems are causing difficulties with your daily activities
- Appropriate sleep promoting behaviors have been addressed
All hypnotics induce sleep and some will help to maintain sleep. They work by acting at areas in the brain believed to be involved in sleep promotion. They are the drugs of choice because they have the highest benefit and the lowest risk as sleep-promoting drugs. Talk to your doctor about the possible side effects of taking hypnotics, such as morning sedation, memory problems, headaches, sleepwalking and a night or two of poor sleep after stopping the medication.
Women who are pregnant or nursing should not take hypnotics. Talk to your doctor about how to cope with insomnia during this time.
Finally, practicing good sleep hygiene may improve the quality of your sleep.
Regardless of what’s causing your sleep problems, it is important to establish and maintain healthy sleep habits. Here are some tips that will help you sleep well:
- Use the bed and bedroom for sleep and sex only
- Establish a regular bedtime routine and a regular sleep-wake schedule
- Do not eat or drink too much close to bedtime
- Create a sleep-promoting environment that is dark, cool and comfortable
- Avoid disturbing noises – consider a bedside fan or white-noise machine to block out disturbing sounds
During the day:
- Consume less or no caffeine, particularly late in the day
- Avoid alcohol and nicotine, especially close to bedtime
- Exercise, but not within three hours before bedtime
- Avoid naps, particularly in the late afternoon or evening
- Keep a sleep diary to identify your sleep habits and patterns that you can share with your doctor