Insomnia Treatment

Behavioral therapy is often used as the first step in a treatment plan. The goal of a behavioral treatment is to retrain behaviors or perceptions towards maximizing sleep quality and establishing a conducive sleep environment or positive sleep patterns. As such, Cognitive Behavioral Therapy for Insomnia (CBT-I) has been shown to outperform sedative-hypnotic medications for the long-term treatment of insomnia. CBT-I includes: 

Establish good sleep hygiene to promote healthy sleep habits. Maintaining a strict sleep-wake schedule throughout your weekdays and weekends is essential in creating a healthy sleep-wake schedule.

Practice relaxation techniques such as yoga, meditation, and guided imagery.

Exercise regularly at least three hours before bedtime.

Use light therapy to shift your circadian rhythm to the desired sleep-wake schedule. The timing of light pulses to shift your circadian rhythm should specifically be tailored to your individual needs.

Sleep restriction therapy. You may have a tendency to spend too much time in bed as you try to make up for a “bad night of sleep.” Spending too much time in bed will typically exacerbate your difficulty to consolidate your sleep at night and will lead to a worsening of your insomnia. Sleep restriction therapy restricts your time spent in bed to approximate your actual total sleep need. By doing so, it leads to a short-term sleep deprivation, but you actually help “train your brain” to consolidate sleep at night.

Stimulus control therapy. You may develop “bad habits” when faced with chronic insomnia, such as frequently watching your clock and “counting down” the time remaining before needing to start their day. You may spend extended periods of time in bed without sleeping or worry about the consequences of having a bad night of sleep. Stimulus control therapy is employed to break your negative associations of the bed as a place of frustration. You will be instructed to not watch the clock and even remove the clock from your bedroom. We recommend you do stay longer than 20-30 minutes in bed without sleeping.

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Getting out of bed when not able to sleep will help break the association of your bed as a place of frustration or dread. Finally, you should not "catastrophize" when faced with a "bad night," but instead, try to view a bad night in a positive light in the sense that the sleep deprivation experienced from a bad night will help consolidate your sleep the following night. Stimulus control therapy is particularly useful if you suffer from chronic "psychophysiologic," or conditioned, insomnia.

Medications are typically used as a second measure and should be specifically tailored for each individual. The treatment of choice will depend on your specific health-related issues and should be directed to the underlying cause of your insomnia. For example, if depression or anxiety is the underlying cause of your insomnia, an antidepressant may be helpful. On the other hand, if heartburn or acid reflux disrupts your sleep, medications to treat acid reflux may be indicated. It is important to note that many medications can worsen or cause insomnia, such as antidepressants, stimulants, beta blockers or other heart medications, decongestants, etc. If your insomnia is caused or exacerbated by a medication you may benefit from switching to a different medication.

If behavioral therapy and the treatment of other underlying medical conditions are not adequate to improve your insomnia, you may be prescribed a sedative-hypnotic and should be closely monitored by your provider. Side effects include a potential risk for drug tolerance and dependence as well as other health risks if combined with alcohol or if you have pre-existing obstructive sleep apnea.