Insomnia Treatments and Medications

Insomnia can be a short-term or chronic condition that is characterized by an inability to fall asleep. Those with insomnia may also experience an inability to stay asleep, or they wake up too early and are unable to fall back asleep. This disruption in sleep patterns can lead to excessive daytime sleepiness, irritability, not feeling well-rested, increased stress, and difficulties with memory, learning, and performing daily tasks. A chronic lack of sleep can often contribute to health problems, such as a weakened immune system, and negative effects on mood, such as depression and anxiety. Continue reading to learn more about insomnia and the different treatment options available, such as lifestyle changes and medications.

How is insomnia diagnosed?

A healthcare provider will look to identify the cause of the insomnia in order to make a diagnosis and recommend treatment options. In some cases, you may be referred to a sleep specialist, psychiatrist, or other specialist. The different causes of insomnia may include stress, chronic pain, certain medical conditions or medications, mental health disorders, and lifestyle factors, such as taking naps late in the afternoon or overconsuming caffeine or alcohol. 

During a diagnosis, a healthcare provider might assess for any risk factors that may be contributing to your insomnia. Risk factors for insomnia can include, but are not limited to, older age, medical conditions like GERD or asthma, medications like decongestants, and a disrupted sleep schedule. 

Different tests and evaluations may be used to confirm a diagnosis of insomnia. A diagnosis may start with a physical exam and an evaluation of your complete medical history. A clinician may recommend a mental health exam to determine whether your emotional well-being may be affecting your ability to sleep. A healthcare provider may also order a blood test to get a full picture of your medical condition. Blood tests can help determine if other health conditions, such as thyroid problems, may be contributing to your insomnia. Other tools that may be used to diagnose primary insomnia include:

Sleep history questionnaire

A clinician will attempt to get a full picture of your sleep history to help confirm a diagnosis of insomnia. They may ask you to keep a sleep diary every day for a couple of weeks that keeps track of different factors like how many naps you take throughout the day, what your exercise habits are like, and what you’re eating or drinking before bed. They may also ask questions like:

• What time do you usually go to bed, and what time do you wake up? 

• Do you relax or work before bedtime?

• Do you have the television on or a bright light turned on while attempting to sleep?

• Are you able to fall back asleep with ease after waking up in the middle of the night?

• What have you tried to help you sleep when you’re unable to sleep?

Sleep study 

Also known as polysomnography, a sleep study is not usually recommended unless your healthcare provider suspects you have obstructive sleep apnea or another sleep disorder. This type of study is done in a sleep clinic where you will wear certain sensors to monitor brain waves, heart rate, oxygen levels, and body movements while you sleep. 

Actigraphy

This type of diagnosis tool can be done at home over days or weeks. Your healthcare provider will ask you to wear an actigraph, which is a device that is worn like a watch on your ankle or wrist to monitor different factors while you sleep. 

Insomnia treatment options

Treatment will depend on the severity of insomnia and what may be causing it. Treatment usually starts with non-pharmacological options like lifestyle changes and cognitive behavioral therapy for insomnia (CBT-I). Exercising regularly and improving sleep hygiene habits, like winding down before bed and removing light and noise, can help manage insomnia. Cognitive behavioral therapy for insomnia is provided by a trained psychologist who will help identify anxieties that may be disrupting sleep patterns and replace those anxieties with positive beliefs about sleep. If non-pharmacological options are not enough, drugs to treat insomnia may be recommended.

Types of insomnia medication

Several different medications are approved by the Food and Drug Administration (FDA) to treat insomnia.

Benzodiazepines

Benzodiazepines have sedative effects that can help calm a person and induce sleep. They work by slowing down activity in the brain. Some examples include Halcion (triazolam) and Restoril (temazepam). Benzodiazepines, which are controlled substances, are not typically recommended as first-line agents because of the potential for abuse and dependence. 

Z-drugs

Z-drugs are non-benzodiazepine sedatives that can help slow down activity in the brain and treat insomnia. These drugs include Ambien (zolpidem), Lunesta (eszopiclone), and Sonata (zaleplon). These medications are sometimes used in people with difficulty falling asleep or problems staying asleep. 

Antidepressants

Silenor (doxepin) is a tricyclic antidepressant FDA-approved to treat insomnia, particularly in people who have problems staying asleep. It is believed to work by blocking the histamine H1 receptor involved with wakefulness and sleep. 

Orexin receptor antagonists

Quviviq (daridorexant), Dayvigo (lemborexant), and Belsomra (suvorexant) are FDA-approved for the treatment of insomnia. They are believed to work by blocking the actions of a chemical called orexin that is involved with wakefulness. 

Over-the-counter insomnia medicine or supplements

Over-the-counter antihistamines are typically used to treat allergy symptoms. However, certain antihistamines like Benadryl (diphenhydramine) and Unisom (doxylamine) have sedative effects, and are sometimes used short-term to treat insomnia. Melatonin is a natural hormone that is involved with the sleep-wake cycle, and it can be purchased as an over-the-counter supplement. Over-the-counter medications are usually only recommended for short-term insomnia. Check with a healthcare provider before using any OTC insomnia medicine, even if it is promoted as a natural supplement.

Melatonin receptor agonists

A melatonin receptor agonist, such as Rozerem (ramelteon), may help in certain cases where people have problems falling asleep. It works by acting like melatonin, which naturally helps regulate the sleep-wake cycle.

The best medication for insomnia depends on several factors, such as the severity of the condition, your overall medical history, and any medications you may be taking. Many people may react differently to the same medication. Therefore, it’s important to consult a healthcare provider for the best insomnia medication for you. The following insomnia medication list can give you an idea of what your healthcare provider may recommend.

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Best medication for insomnia