How to treat insomnia and get better sleep with self-care, therapy, or medication

Rebecca CairnsMay 28, 2020, 03:56 IST

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Many people are able to effectively treat their insomnia.Stokkete/Shutterstock

To treat insomnia and get better sleep, you may need a combination of lifestyle changes, therapy, and medication.
Cognitive behavioral therapy for insomnia (CBT-I) and light therapy can be very effective at treating insomnia and resolving sleep troubles.
In some cases, home remedies like exercise or meditation will be enough to get better sleep — and these natural sleep aids can always help, and carry a much lower risk than prescription medication.
This article was medically reviewed by Alex Dimitriu, MD, psychiatrist and founder of Menlo Park Psychiatry and Sleep Medicine.

Insomnia is a sleep disorder, characterized by difficulty falling and staying asleep. It requires a doctor's diagnosis to determine the underlying cause, and can usually be treated with lifestyle changes, therapy, or medication.

Insomnia can be acute or chronic

There are two types of insomnia:

Acute or short-term insomnia is when you have occasional trouble with quality sleep for up to three months.
Chronic insomnia is defined as occurring at least three times a week for more than three months.

To diagnose insomnia, your doctor will ask about your medical history, sleep history, bedtime routine, and lifestyle, and conduct a physical examination to check for other medical problems. After that, your doctor will discuss treatment options.

Insomnia treatment

Anyone with insomnia will be able to improve sleep by making small lifestyle changes, says Minesh Morker, MD, a clinical neurophysiologist and sleep medicine specialist at Northwestern Medicine Kishwaukee Hospital.

These natural remedies for insomnia include:

Sleep hygiene. Morker says poor sleep hygiene is common for insomnia patients, and recommends avoiding using your phone, laptop, or watching TV immediately before bed, as light inhibits the production of melatonin, a hormone that aids sleep.
Exercise. A 2015 meta-study found that regular exercise improved quality of sleep in insomnia patients, with similar comparable benefits to therapy and medication.
Diet. While no single diet has been recommended, research suggests that a regular diet of high fiber, low sugar, and limited saturated fat can improve sleep quality — such as the Mediterannean diet or DASH diet.

Additionally, Morker says that having a dark and quiet room to sleep, sticking to consistent sleep and wake times, refraining from naps, avoiding alcohol, and trying relaxation techniques like meditation or deep breathing can all help someone with insomnia.

However, for those with chronic insomnia, these lifestyle changes may not be enough to effectively resolve sleep troubles.

Chronic insomnia is classified in two ways:

Primary insomnia is a sleep condition in itself and not the result of another condition. It can often be treated with a combination of lifestyle changes, therapy, or medication.
Secondary insomnia is caused by another health condition, including sleep disorders like sleep apnea and restless leg syndrome, or mental illnesses like depression. It can only be fully treated by addressing the underlying condition.

Cognitive behavioral therapy for insomnia

Cognitive behavioral therapy for insomnia (CBT-I) is an effective option for those with chronic sleep troubles. During CBT-I, a therapist will help you address harmful thoughts and anxieties that may be disrupting your sleep.

CBT-I often includes:

Private or group talk therapy sessions
Creating a sleep schedule and bedtime routine
Sleep restrictions, or reducing the time you spend in bed outside of sleep
Learning relaxation techniques, such as deep breathing or meditation
Keeping a sleep diary

A 2018 study from Royal College of General Practitioners found that just four to eight CBT-I sessions were effective in reducing both the time it takes to fall asleep and the time spent awake during the night. In fact, the improvements in sleep quality were even maintained for up to 12 months post-therapy.

"It also helps you learn new strategies to sleep better," says James Rowley, MD, President of the American Academy of Sleep Medicine (AASM). "CBT-I can include techniques for stress reduction, relaxation, and sleep schedule management."

CBT-I may also encompass other types of therapy. For example, stimulus control therapy can teach you how to implement consistent sleep and wake times, avoid naps during the daytime, and what to do if you are not able to fall asleep or wake up too early.

Light therapy

Light therapy can help patients adjust the body's circadian rhythm, an internal biological clock that responds to light and darkness in order to initiate sleep.

This method of therapy can be particularly useful for those who have insomnia due to circadian rhythm sleep disorders, such as sleep phase delay syndrome.

Studies have found that as people age, circadian rhythms are more likely to be interrupted, and the risk for developing a sleep disorder increases with age. A 2018 study found insomnia in the elderly ranges between 30% to 48%, compared to 12% to 20% in the general adult population.

As a result, light therapy may be one of the best options for older patients with insomnia, as taking medication carries more potential risks, and light therapy can reset circadian rhythms and improve sleep quality safely.

However, Morker warns against treating yourself without a therapist. "This can be an effective treatment if done appropriately, but if you don't know what you're doing, you can make things worse by shifting the internal clock in the opposite direction," he says.

Medication

Medication is only used to treat insomnia on a short-term basis, as prescription sleeping pills are known to have potentially harmful risks.

Sleeping pills might be prescribed to you to help you adjust to a new sleeping schedule as part of your CBT-I, or for some cases of short-term insomnia triggered by a stressful event.

A few common types of medications for insomnia, called sleeping pills or hypnotics, include:

Benzodiazepines. Examples are triazolam, estazolam, temazepam, quazepam, and flurazepam.
Non-benzodiazepines. These 'Z drugs,' as they're known, include zolpidem, zaleplon, and eszopiclone.

According to AASM's 2017 Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults, eszopiclone and zolpidem were the two hypnotics most recommended for the treatment of insomnia, and Rowley notes both are commonly used by sleep physicians.

Moreover, a 2018 review found that when these medications were used in combination with CBT-I, results were better than with the use of CBT-I alone. The study recommended starting the use of hypnotics early in treatment, and slowly weaning the patient off the hypnotics as they progress with therapy.

However, that study also noted the danger of potential side effects with benzodiazepines and Z drugs — such as nausea, headaches, and extended drowsiness that can impair your ability to drive the next day. Even though these medications may be effective in the short-term, the risks often outweigh the benefits.

And even though over-the-counter medication, like melatonin, may seem helpful and harmless, Rowley advises against its use.

"There are insufficient studies available on the safety and effectiveness of most over-the-counter sleep aids, including melatonin," says Rowley.

Additionally, Rowley warns against plant-based herbal remedies like kava and valerian root for the treatment of insomnia, because they also lack evidence on their efficacy.

The bottom line

Overall, consulting with a medical practitioner to work out the root of your sleeping problems is the best way to find a treatment path that suits you — whether it's therapy, lifestyle changes, medication, or a combination of all three.

Rowley recommends speaking to your doctor first, who may then refer you to an accredited sleep center for further help.

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