Because there are several causes for insomnia, the condition requires a number of different treatment options and therapies. Often, treatment for insomnia is directed at the underlying cause of sleep deprivation. For instance, therapy for insomnia caused by asthma includes intensification of asthma treatment and elimination of drugs that may cause insomnia.
Treatment for insomnia due to DSPS may include chronotherapy, also called bright light therapy. Insomnia due to depression or anxiety includes treatment for the underlying psychiatric disorder.
In many cases, recognition of conditions like depression and anxiety includes a diagnosis of disordered sleep, so treatment for the psychiatric disorder is tailored to address sleep problems. Often times, along with treatment directed at a specific sleep condition, general symptomatic therapy is provided. Treatment may include good sleep hygiene, cognitive-behavioral therapy, and medications.
Sleep hygiene refers to activities or practices that either promote sleep or hinder it. Many people with normal sleep habits have poor sleep hygiene, but it does not appear to affect them. People with insomnia, on the other hand, may be very susceptible to poor sleep hygiene.
Good sleep hygiene practices include the following:
- Standard wake-up timeIt is tempting to sleep in on weekends, especially if one has had poor sleep during the week. This should be avoided with patients with insomnia in order to train the body to wake at a consistent time.
- Eliminate nicotine, caffeine, alcohol, and other stimulantsThis includes theophylline, beta agonists (usually as inhalers), and steroids, especially prior to bedtime. Nicotine and caffeine are stimulants that provoke arousal. The effects of caffeine can last for several hours, perhaps up to 24 hours, so the chances of it affecting sleep are significant. Caffeine may not only cause difficulty initiating sleep, but may also cause frequent awakenings. Alcohol may have a sedative effect for the first four hours following consumption, but it can then lead to frequent arousals and non-restful sleep.
- Avoid nappingWhile napping seems like a proper way to catch up on missed sleep, it is not. Napping can be considered good sleep at a bad time. Typically, proper sleep hygiene practice involves establishing and maintaining a regular sleep pattern and associating sleep with cues like darkness and a consistent bedtime. Napping may prove temporarily rewarding, but it diminishes the effects of long-term therapies.
- ExerciseRegular exercise can promote sleep quality and duration. However, exercising immediately before bedtime can have a stimulant effect on the body and should be avoided.
- Limit activities in bedPeople suffering from insomnia should avoid working in bed, such as balancing the checkbook, studying, making phone calls, and other distractions, like using the computer, watching television, or listening to the radio. All these activities can increase alertness and make it difficult to fall asleep. Also, these habits may lead a person to associate wakefulness with bedtime and may counteract the body's preparation for sleep.
- Avoid food and drink before bedEating a late dinner or snacking before going to bed can activate the digestive system and cause arousal and should be avoided. Excessive drinking prior to bed can overwhelm the bladder, causing wakefulness and the need to use the bathroom. Avoiding both liquids and food before bedtime can reduce the incidence of gastroesophageal reflux (GERD) and heartburn, which can disrupt sleep.
- Ensure an adequate sleep environmentTemperature and lighting should be controlled to make the bedroom conducive to falling asleep. A comfortable or uncomfortable bed can affect a person significantly, though it may not be immediately noticeable. Isolation from loud noise or pets is also a sensible way of ensuring sound sleep.
- Worry timeIt can be very helpful to set aside a period of time at night to review the day and to make plans for the next day. The goal is to avoid doing these things while trying to fall asleep. It is also useful to make a list of, say, work-related tasks for the next day before leaving work.
- Relaxation therapyRelaxation therapy and stress reduction methods may consist of a variety of techniques, including progressive relaxation (perhaps with audio tapes), meditation, and biofeedback. The goal of all these interventions is to improve relaxation and relieve anxiety and arousal at bedtime. Calming the body often helps prepare it for sleep.
- Cognitive-behavioral therapy (also called sleep restriction and stimulus control)Cognitive-behavioral therapy can help promote good sleep habits and reduce anxiety related to sleep. Sleep restriction therapy involves limiting the amount of time spent in bed to time actually sleeping. Being in bed while awake causes increased anxiety and prohibits sleep. Therefore, in sleep restriction therapy, a person is encouraged to get out of bed if sleep is not possible. Also, sleep restriction therapy uses stimulus control to promote consolidated and restful sleep after sleep onset.
For example: A person who spends eight hours in bed estimates his or her total sleep time to be 5 hours. Upon going to bed, this person sets his or her alarm to go off 5 hours later. If he or she were not asleep within 20 minutes, then he or she would get out of bed and wait until tired again (stimulus control). The person returns to bed and resets the alarm clock for five hours later.
Once he or she is sleeping about 90 percent of the time spent in bed (sleep efficiency) for five consecutive days, then he or she increases the amount of time spent in bed by small amounts. If sleep efficiency of 90 percent is maintained, then therapy is successful. Behavior modification stimulus control of this nature is intended to establish a connection between the bed, bedtime, and rapid sleep onset. However, this treatment does not work for everyone.