Treatments & Remedies for Insomnia


You couldn’t fall asleep until 3 a.m. and woke up feeling like you hadn’t slept at all. Then you snap at your S.O. for the smallest thing that normally wouldn’t bother you. Sound familiar? Whether you’re dealing with acute or chronic insomnia, all you want to do is figure out how to get better sleep so you can feel like yourself again.

According to the National Heart, Lung, and Blood Institute, about 50 to 70 million Americans have sleep disorders, and 1 in 3 adults do not regularly get the recommended amount of sleep needed to protect their health (1)

If you are experiencing difficulty sleeping, you should schedule time to talk to your doctor about your symptoms. Your doctor can help determine the cause of your sleeping difficulties and the best treatment for you. If you’re diagnosed with sleep apnea — which involves undergoing a sleep study — then your treatment options are different than for people suffering from insomnia. If you’re diagnosed with insomnia, your doctor may suggest one of the following treatments:

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Cognitive Behavioral Therapy for Insomnia, often referred to as CBT-I, is recommended by the American College of Physicians as the first line of treatment for insomnia (3). Unlike sleeping pills, CBT-I encourages good sleep habits by identifying and eliminating the thoughts and behaviors responsible for disrupting your sleep and replacing them with attitudes and habits that promote good quality sleep. CBT-I uses well-established methods to treat chronic insomnia, including sleep restriction therapy, stimulus control, relaxation techniques, and sleep hygiene education. A study conducted in 2004 even found CBT-I to be more effective than sleeping pills! Not only does CBT-I improve sleep in 75%–80% of insomnia patients, it can also reduce or eliminate sleeping pill use in 90% of patients (4).

Though CBT-I is usually done in-person with a trained medical professional, there are several apps and online programs that have proven to be an effective alternative to in-person treatment (5). These apps provide assessments and help you keep daily sleep diaries before and during treatment.

Melatonin supplements

Melatonin is a hormone that is produced naturally in your body by the pineal gland and regulates your sleep-wake cycle. Melatonin is available as a supplement over-the-counter and can be taken safely as a natural sleep aid. It is non-habit forming but can cause drowsiness that may affect balance in some people. It should be used with caution in people with a history of depression or a weakened immune system from any cause because it can make these disorders worse. Melatonin should be taken 1 to 2 hours before bedtime to help the body naturally get sleepy. Melatonin can help with jetlag and other short-term sleep disturbances in addition to treating insomnia.

Prescription medications

Your doctor may write you a prescription for sleeping pills for short-term or longer use. Be sure to ask about potential side effects, including daytime grogginess and sleepwalking, and whether the medication is habit-forming. Your doctor should also talk to you about any mental health problems, as some sleep aids can increase the risk of depression and suicide (6).

Common prescription sleep medications include orexin receptor blockers (Suvorexant), benzodiazepines (Flurazepam, Triazolam, Temazepam, Diazepam, Alprazolam, and Lorazepam), and non-benzodiazepine hypnotics (Zolpidem, Eszopiclone, and Zaleplon).

Prescription medications and over-the-counter supplements are generally meant for short-term use and are most effective when you also make lifestyle and behavioral changes that promote better sleep.

Light therapy

If you have tried other forms of treatment with no success, you might ask your doctor if light therapy could be helpful. Light therapy involves sitting in front of a light box that mimics outdoor light for 30 to 40 minutes to help adjust your circadian rhythm. It’s ideal to do this first thing in the morning, after you wake up, which can help you fall asleep earlier at night (7).

It’s best to use light therapy under the supervision of a doctor, therapist, or sleep specialist. They can help you choose the best box with the right intensity and get you on an individualized treatment plan.

Lifestyle factors can also contribute to insomnia, so start by improving your sleep hygiene. If that doesn’t work, talking to your doctor or a healthcare professional can get you on your way to restful and restorative sleep.

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References

Sleep Health | National Heart, Lung, and Blood Institute (NHLBI). https://www.nhlbi.nih.gov/health-topics/education-and-awareness/sleep-health. Accessed March 22, 2019.

Sleep Apnea (OSA). American Lung Association. https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/sleep-apnea/. Accessed March 22, 2019.

ACP Recommends Cognitive Behavioral Therapy as Initial Treatment for Chronic Insomnia | ACP Newsroom | ACP. https://www.acponline.org/acp-newsroom/acp-recommends-cognitive-behavioral-therapy-as-initial-treatment-for-chronic-insomnia. Accessed March 22, 2019.

Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. 2004;164(17):1888-1896.

Luik AI, Kyle SD, Espie CA. Digital Cognitive Behavioral Therapy (dCBT) for Insomnia: a State-of-the-Science Review. Curr Sleep Med Rep. 2017; 3(2):48–56.

Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(3):191-204.

Frequently Asked Questions about CBT-I. Cognitive Behavioral Therapy for Insomnia Frequently Asked Questions. https://www.pennsleep.directory/index.php/cbt-i-faq#what-can-i-expect-treatment-to-be-like. Accessed March 12, 2019.

McCall WV, Benca RM, Rosenquist PB. Hypnotic Medications and Suicide: Risk, Mechanisms, Mitigation, and the FDA. Am J Psychiatry. 2017;174(1):18-25.