Treatment Options for Insomnia

Is it ironic to write a story about insomnia treatments after you’ve been tossing and turning all night? I think so. But I know my restless night was just that — a restless night.

Insomnia, however, is more than just a restless night. It’s a serious sleep disorder. “It’s not just about being unable to sleep — you have to see a specialist to properly diagnose insomnia,” said Monica Mallampalli, Ph.D., CEO of Alliance of Sleep Apnea Partners and member of HealthyWomen’s Women’s Health Council.

Without proper diagnosis and treatment, insomnia can lead to health problems like heart disease, diabetes and depression.

So how do you know if you have insomnia? The sleep disorder is defined as being unable to sleep, stay asleep or feel rested for three or more nights a week even though you’ve had the opportunity to sleep. Insomnia happens even when you’re in the right place at the right time (for example, in bed at a reasonable hour). And the lack of sleep has a negative impact on everyday life.

Short-term insomnia lasts days or weeks and is usually caused by stress or a change in your life, like a job change. Chronic insomnia, also called long-term insomnia, lasts three or more nights a week for more than three months. Some researchers think insomnia may be caused by your brain staying active when you’re sleeping.

If any of this sounds familiar or you’ve been googling “Why can’t I sleep?” at all hours of the night, you’re not alone. As many as 4 out of 10 adults in the United States have symptoms of insomnia — and most of them are women.

​Insomnia causes and symptoms

Women are more likely to
experience insomnia compared to men. Research is ongoing as to why. But studies show that hormonal changes during puberty, pregnancy and menopause (hello, hot flashes and night sweats) can cause insomnia.

One
report found that about 6 out of 10 women in the U.S. affected by hot flashes reported sleep issues and insomnia. “Clearly there’s a hormonal component,” Mallampalli said.

In addition to biological factors, common causes for insomnia include:

Stress
Anxiety
Changes in work or travel schedule
Bad sleeping habits

Insomnia is a complex disorder that has many different causes. Even your job and relationship status can affect your risk for insomnia. One recent
study found that people who are unemployed; widowed, divorced or separated; and of lower socioeconomic status have higher rates of insomnia.

People in certain occupations that require irregular sleep hours, like first responders, which includes police officers and firefighters, are more likely to have sleep problems compared to the general public. And active-duty service members and veterans are also at
high risk for insomnia, also in part because of unstable sleep schedules and in part because of the physical and emotional demands of their roles.

​Physical and mental effects of insomnia

Many people with insomnia have medical and/or mental health conditions in addition to insomnia.

“Just be aware that insomnia has comorbid conditions. For example, insomnia is pretty closely tied to sleep apnea, so be aware that other things may be happening that are leading you to not fall asleep,” Mallampalli said.

About half of people with insomnia have a medical condition. And chronic insomnia puts you at higher risk for health problems, including:

Hypertension Type 2 diabetesHeart attack StrokeChronic painObesity

When it comes to mental health, about half of people with insomnia have a mental health condition like anxiety, post-traumatic stress disorder (PTSD) and depression. In fact, about 8 out of 10 people with major depressive disorder have insomnia.

Recent research also found that sleep disorders are a common symptom in patients with neurodegenerative diseases like Alzheimer’s and Parkinson’s.

The lack of sleep and the stress that often comes with not being able to sleep can have a big impact on your waking hours.

The negative effects include:

Delayed reaction timeLack of focus Memory issuesDifficulty sticking to routine and/or treatment for substance abuse

Read: The Day After a Bad Night’s Sleep >>

Over time, the effects of insomnia not only hurt your health but can have a negative effect on your personal and professional relationships.

​Insomnia treatments

Insomnia can be hard to treat, especially when considering other health conditions that might be at play. Some medications can make it hard to fall asleep. And prescription sleeping pills may interact with other medications you’re taking.

Mallampalli said the first thing to do is talk to your HCP about your symptoms. Your HCP may refer you to a sleep specialist.

Treatment options vary from person to person, and your HCP may recommend one or a combination of treatments, which may include lifestyle changes, cognitive behavioral therapy (CBT) or medication.

CBT is usually the first step in treating insomnia. It teaches strategies to change behavior and thinking associated with sleep disorders and can help you identify thoughts and habits that are causing sleep problems.

Research shows that CBT can work. One analysis found big improvements in sleep quality and total sleep time in people with insomnia.

CBT is also an option for people who can’t or don’t want to take medication. Overall, CBT has few side effects, but changing your habits takes time and you won’t see results overnight.

Healthy sleep habits, also called sleep hygiene, can be practiced on their own or as part of CBT. They include cutting down on caffeine during the day and setting a sleep schedule in addition to learning meditation and other mental techniques.

Watch: How to Get a Good Night’s Sleep >>

​Medications for insomnia

Medications for insomnia fall into a few categories. These include:

Benzodiazepines: Medications to slow down the activity in your brain to help you fall asleep and stay asleep. Benzodiazepines were once the go-to prescription medication for insomnia, but research has shown that benzodiazepines can lead to dependence and carry a risk for abuse and dependence and are not recommended for long-term use.

Non-benzodiazepines: Also known as Z-drugs, this class of prescription-only medications (think Ambien and Sonesta) work by slowing activity in the brain similar to benzodiazepines. Studies show that Z-drugs have less potential for dependency and abuse compared to benzodiazepines, but side effects can include nausea, headaches and dizziness. Z-drugs are for short-term use, and not everyone should take them.

Melatonin receptor agonists: Melatonin is a natural hormone that is available over the counter. Research shows that taking melatonin can help some people fall asleep faster, but it’s not clear if melatonin can help with sleep quality or the amount of time you sleep. Melatonin can have side effects like drowsiness the next day and headache and is also not for long-term use.

Read: More on Melatonin >>

Dual orexin receptor antagonists (DORAs): DORAs are the newest class of medications to treat insomnia. The drugs block chemicals (orexins) in the brain that tell you to stay awake. Studies show that DORAs can reduce insomnia symptoms and improve overall quality of sleep in people with insomnia. DORAs don’t have the risk of dependence or abuse associated with benzodiazepines or other sleep-inducing drugs. Side effects include daytime sleepiness.

Insomnia is complicated. But with the right treatment plan, good sleep is possible. “If [insomnia] is truly impacting your life and you’re unable to sleep — see a sleep specialist,” Mallampalli said. “They can help tease out what the problem may be.”