Insomnia Treatments and Medications

We spend about one-third of our lives sleeping on average. After all, sleep is essential for optimal health and well-being. Insomnia can not only be hard to deal with, but it can also have a profound effect on quality of life. A chronic lack of sleep can often lead to health problems, such as chronic stress, 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.

What is insomnia?

Insomnia is a common sleep disorder that affects around 30% to 40% of adults in the United States in a given year. It 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 symptoms of insomnia like excessive daytime sleepiness, irritability, not feeling well-rested, increased stress, and difficulties with memory, learning, and performing daily tasks.

How is insomnia diagnosed?

A doctor or clinician will look to identify the cause of insomnia in order to make a diagnosis and recommend treatment options. In some cases, you may be referred to a sleep specialist or psychiatrist. The different causes of insomnia may include stress, chronic pain, certain medications, mental health disorders, and poor lifestyle choices, 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:

• Older age: Older adults over the age of 60 are more likely to have insomnia because they are more likely to have certain medical conditions or medications that may interfere with sleep patterns.

• Chronic conditions: Certain medical conditions like asthma, gastroesophageal reflux disease (GERD), and chronic pain can make it hard to sleep.

• Medications: Different medications may cause insomnia as a side effect. These medications may include corticosteroids, decongestants, certain blood pressure medications, and some antidepressants like selective serotonin reuptake inhibitors (SSRIs).

• Lifestyle choices: An irregular sleep schedule, exercising close to bedtime, and using the phone or computer in bed are examples of lifestyle habits that can contribute to acute or chronic insomnia.

• Poor sleeping environment: Too much noise, heat, or bright lights can interrupt your ability to get a good night’s rest.

• Working the night shift: Working at night can disrupt a person’s circadian rhythm and make it hard to get enough sleep during the day, which can contribute to sleep problems.

• Gender: The risk of insomnia is 40% higher in women than in men. Insomnia is also common in women after menopause.

• Prolonged travel by plane: Jet lag is a common problem that can cause temporary insomnia due to disruptions in the circadian rhythm while traveling.

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 doctor 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 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 doctor 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 doctor 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 replacing those anxieties with positive beliefs about sleep. If non-pharmacological options are not enough, medications may be recommended.

Insomnia medications

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. Brand names include Halcion (triazolam) and Restoril (temazepam). Benzodiazepines are not typically recommended as first-line agents because of the potential for abuse and dependence.

Barbiturates

Barbiturates work as central nervous system depressants that slow down activity much like benzodiazepines. An example is Seconal (secobarbital). Barbiturates are not prescribed often for insomnia due to the availability of newer, safer alternatives.

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 considered first-line medications for those with difficulty falling asleep or problems staying asleep.

Antidepressants

Silenor (doxepin) is a tricyclic antidepressant FDA-approved to treat insomnia. It is believed to work by blocking the histamine H1 receptor involved with wakefulness and sleep.

Orexin receptor antagonist

Belsomra (suvorexant) is FDA-approved for the treatment of insomnia. It is believed to work by blocking the actions of a chemical called orexin that is involved with wakefulness. It may be prescribed for those who are unable to fall asleep or those who are unable to stay asleep.

Over-the-counter medicines

Over-the-counter antihistamines are typically used to treat allergy symptoms. However, certain antihistamines like Banophen (diphenhydramine) and Unisom (doxylamine) have sedative effects. Melatonin is a natural hormone that is involved with the sleep-wake cycle, and it can be purchased as an over-the-counter supplement. Valerian is an herbal supplement that may also help with insomnia. Over-the-counter medications are usually only recommended for short-term insomnia.

What is the best medication for insomnia?

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.

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Best medications for insomnia