Treatment and Medication Options for Insomnia
People with insomnia might feel there’s no hope for relief, but it can be overcome, and current treatment therapies are highly effective.
Tried-and-true sleep hygiene strategies, like keeping consistent sleep and wake times, avoiding stimulating activities before bed, and shutting down electronic devices 30 to 60 minutes before bed, usually help sleep problems and often alleviate them completely. These strategies are recommended for insomnia prevention, too.
Once sleep problems become chronic, these strategies aren’t as effective in reversing sleep difficulties — though they’re often still recommended to keep insomnia from becoming worse and help make other treatments more effective, Meskill says.
Cognitive Behavioral Therapy
Although prescription medication may be used in some cases, cognitive behavioral therapy for insomnia (CBTi) — a type of psychotherapy or talk therapy — is now considered the gold standard for chronic insomnia treatment. “CBTi is generally recommended as first-line therapy for chronic insomnia,” says Sheila Tsai, MD, pulmonologist and section head of sleep medicine at National Jewish Health in Denver.
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With CBTi, you’re essentially retraining your brain and body on how to sleep. “People with chronic insomnia develop an aversion to their bed and bedroom and the act of sleeping,” Meskill says. CBTi works to erase that aversion by training people to use techniques specifically targeting the psychological factors associated with insomnia, such as having negative emotions and worries about not being able to sleep.
CBTi can involve breathing techniques, muscle relaxation practices, and other complementary therapies that can help you get to sleep. It can also involve changing your sleep routines or bedroom environment in ways that promote sound sleep.
Although doing CBTi with a trained specialist in person is the best option, online programs can also be effective, especially with people who are self-motivated and highly disciplined, or who live somewhere where there is no CBTi specialist, Meskill says.
How long it will take to overcome chronic insomnia depends on each individual. For some, the therapy may reverse sleep problems in just a few weeks, while others need several months. Just like other health conditions, though, there is a chance of relapse, which is why it’s important to remember the behavioral skills you learn in CBTi and practice them if and when your sleep starts to get disrupted again, Nowakowski says.
Medication Options
Prescription sleeping pills do play a role in insomnia management, but they should be used with caution and only for a short period of time. They can come with serious side effects, and they can be habit-forming if relied on for too long. Taking these frequently can lead to physical dependency, meaning you might need more to go to sleep or not be able to sleep without them, Dr. Tsai says.
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Still, medicine may help prevent a bout of short-term insomnia from turning into a chronic problem, or help jump-start a healthier sleep pattern for someone with chronic insomnia. The idea is that you use the medication for a few nights to get back to a healthy sleep schedule, then stop the pill after you’ve fallen back into that good routine.
Many people also reach for over-the-counter sleep aids, such as melatonin. Our bodies naturally produce melatonin, a hormone that triggers a series of reactions that help our brains and bodies fall asleep. It’s available as a supplement and, according to research, does not carry the same risk as other prescription sleep aids of becoming addictive.
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