Insomnia

Diagnosis

Depending on your circumstances, the diagnosis of insomnia and the investigation into its root cause may involve:

• Physical examination: If the cause of insomnia is unknown, your doctor may conduct a physical examination to identify signs of medical issues related to sleep disturbances. In some cases, a blood test may be performed to check for conditions such as thyroid problems that may be linked to poor sleep.
• Review of sleep habits: Alongside inquiring about your sleep, your doctor may ask you to complete a questionnaire illustrating your sleep-wake patterns and daytime sleepiness levels. Additionally, you might be requested to maintain a sleep diary for a couple of weeks.
• Sleep study: If the cause of your insomnia remains unclear, or if there are indications of another sleep disorder like sleep apnea or restless legs syndrome, a night at a sleep center may be recommended. During this stay, tests are conducted to monitor and record various bodily activities during sleep, encompassing brain waves, breathing, heartbeat, eye movements, and body movements.

Treatment

Adopting healthier sleep practices and addressing factors contributing to insomnia, such as stress, medical conditions, or medications, can lead to restful sleep for numerous individuals. In cases where these adjustments prove ineffective, your doctor may suggest Cognitive-Behavioral Therapy (CBT), medications, or a combination of both to enhance relaxation and improve sleep.

CBT for insomnia

Cognitive-behavioral therapy for insomnia (CBT) is designed to empower individuals to manage or stop negative thoughts and behaviors that contribute to sleep difficulties. It is often recommended as the initial approach for those dealing with insomnia and is typically as effective, if not more so, than sleep medications.

The cognitive aspect of CBT focuses on identifying and modifying beliefs that impact sleep, assisting individuals in gaining control over negative thoughts and worries that hinder sleep. It also involves breaking the cycle of excessive concern about falling asleep, which can itself impede the ability to do so.

The behavioral component of CBT aims to instill healthy sleep habits and stop behaviors that hinder restful sleep. Strategies include:

• Stimulus control therapy: This method assists in training your mind and body to enhance sleep quality without resisting the natural urge to sleep. It involves establishing a consistent bedtime and wake-up time, avoiding daytime naps, and using the bed solely for sleep and intimate activities. Leaving the bedroom if unable to sleep within 20 minutes is also part of the approach, returning only when sleepy.
• Relaxation methods: Techniques such as progressive muscle relaxation, biofeedback, and breathing exercises help reduce bedtime anxiety. Practicing these methods allows individuals to manage breathing, heart rate, and muscle tension for relaxation.
• Sleep restriction: This method involves reducing time spent in bed and eliminating daytime napping to induce tiredness. As your sleep quality improves, you progressively extend the duration of time spent in bed.
• Paradoxical intention (remaining passively awake): This technique aims to diminish worry and anxiety about falling asleep. Instead of expecting to sleep, individuals intentionally try to stay awake while in bed. This approach reduces hyperfocus on sleep and anxiety, facilitating an easier transition into sleep.
• Light therapy: For those who fall asleep too early and wake up prematurely, light therapy can help reset the internal clock. Exposure to natural light in the evening or using a light box can be beneficial; however, consultation with a doctor is advised.

In addition to these techniques, your doctor may recommend lifestyle and sleep environment adjustments to establish habits conducive to sound sleep and daytime alertness.

Prescription medicines

Prescription sleep medications are designed to assist individuals in initiating or maintaining sleep, or both. Generally, doctors advise against relying on these medications for an extended period, typically not exceeding a few weeks. Medications should not be the sole treatment; instead, their use is determined on a case-by-case basis, with patients and doctors weighing the benefits and potential risks. It is advisable to use the lowest effective dose and refrain from prolonged medication use.

Options for treating difficulty falling asleep include:

• Triazolam
• Zaleplon
• Zolpidem tartrate
• Eszopiclone
• Ramelteon
• Temazepam

For those experiencing trouble staying asleep, waking too early, or struggling to return to sleep, options include:

• Suvorexant
• Temazepam
• Zolpidem tartrate
• Doxepin hydrochloride
• Eszopiclone

Prescription sleep medications may have side effects, such as daytime grogginess and an increased risk of falls. Additionally, they can be habit-forming.

When prescribed a sleep aid, it’s essential to seek detailed information from your doctor, including potential side effects and the recommended duration of use.

Over-the-counter sleep aids

Over-the-counter sleep aids, which do not require a prescription, include antihistamines. It’s crucial to understand that these medications are not intended for routine use. Prior to using these medicines, it is advisable to consult with your doctor, as antihistamines may cause side effects. Potential side effects encompass daytime drowsiness, dizziness, confusion, thinking problems, and challenges with urination. It is particularly important to note that these side effects may be more pronounced in older adults.