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Guidelines for Insomnia Treatments

The guidelines for treating insomnia comprise of non-pharmacologic as well as pharmacologic treatments.


Non-pharmacologic treatment

Non-pharmacologic treatment is the main method for treating insomnia. It consists of:

  1. Good Sleep Hygiene. This is both very important and necessary, as it is the foundation for treating insomnia in every patient. It is possible to practice good sleep hygiene by adjusting the environment of your bedroom to make it conducive to a restful sleep, along with following a routine that entices you to fall asleep naturally – for example, appropriately rigorous exercises in the late afternoon that boost more homeostasis, or maintain consistent sleep schedule in a completely darken bedroom so that the circadian rhythm can function effectively without any interference from external stimulant, etc. Details of how you can adjust the environment and your body’s homeostasis are shown in Table 1.
  2. Progressive Relaxation Training which helps relax the muscles and enable better sleep.
  3. Cognitive-Behavioral Therapy. Here, the emphasis is on reshaping your thoughts, which leads to the transformation of habits and emotions. The therapy is very helpful for patients whose symptoms arise together with emotional malady and for those with anxiety disorder.
  4. Stimulus Control.
  5. Sleep restriction. For a patient with severe symptoms or other already existing afflictions, the doctor will prescribe good sleep hygiene and other non-pharmacologic treatments together with pharmacologic treatment which is described below.

Table 1: Adjustment of the environment and your body’s homeostasis for your sleep

Circadian Rhythm

Homeostasis

Go to bed when sleepy.

Avoid afternoon nap.

Bedroom should be quiet, has the right temperature and has little or no light.

Avoid using stimulants such as caffeine and alcoholic drinks in the evening and night. 

Bedroom should be for sleeping not for other activities such as watching TV or playing games.

Avoid a large meal before bedtime.

Go to bed at the same time every night.

Exercise regularly.  Do not exercise rigorously before bedtime.

If you cannot fall asleep within 15-20 mins, don’t drag on.  It is recommended that you do other activities until you are ready to sleep.

Avoid stimulating activities such as watching horror movies before bedtime.

Pharmacologic treatment

Pharmacologic treatment is already well-known to the public. These medicines are usually called “sleeping pills,” but they are not of any type of drug specifically.  In fact, the name refers to a collection of different types of medicine whose direct or indirect effect is to cause drowsiness and allows a person to fall asleep more easily.  So, there are many kinds of sleeping pills, each with its own action or side-effect.

For the type of pills that has a direct effect to the brain is the benzodiazepines class of drugs.  Its action is to enhance the the effect of neurotransmitter gamma-aminobutyric acid (GABA) in the brain.  Heightened level of GABA directly causes the patient to fall asleep.  In addition, it lessens the patient anxiety, prevents seizures, and relaxes the muscles also.  However, this class of drugs has many side-effects because most remain active for longer period than a person’s normal sleep, which makes the patient feel sleepy or drowsy in the morning.  This impaires the patient’s ability to function effectively and risks causing accidents.  Moreover, if a patient takes benzodiazepines for an extended period, he/she is likely to become more reliant on the drug and the brain will respond to it less effectively, which will require gradually higher dosages to maintain the same level of efficacy.  This will increase the risks of other side-effects as well as the possiblity of becoming addicted to the drug.  Further, if the patient stops benzodiazepines after he/she has been taking them for an extended period, there is also a risk of drug withdrawal – for example: trembling hands, palpitation, depression, or even seizures.

Firstly, the popular class of medicine that makes the patient feel sleepy is antihistamine, which can be found in nasal congestion remedy.  A side-effect of this class of medicine is to cause drowsiness, but the efficacy may not be very substantial and can vary depending on each patient. 

Another class of medicine – for example, antidepressants – is the one usually used to treat neurological sickness or psychological disorder.  This type of medication has many side-effects and, therefore, should only be used specifically for insomniac patients who are also suffering from these ailments.

Nowadays, melatonin – a natural hormone that encourages sleep – has also been used to help treat insomnia.  It is found that melatonin is effective as a remedy for jet lag or for helping people who work irregular hours shifts.  However, its direct effectiveness in treating insomnia is still unclear as there is insufficient research data for its long-term results.

In particular, pharmacologic treatment option should be selected only as necessary, starting from the lowest possible dosage and not to continue for an extended period. This is to avoid the risk of undesirable effects of medication, especially as they could even be life-threatening or cause cancer. Any amount of sleeping pills, however miniscule, increases the exposure.

In summary, insomnia is a health issue that is frequently found among regular groups of people or those with a history of other diseases.  Moreover, its symptoms can indicate some types of brain or neurological disorder also.  Therefore, understanding human sleep mechanism has an impact on the diagnosis, cause determination, and treatment of insomnia.  It is critical that your doctor has a detailed record of your sleep habits as well as any health history that may affect your ability to sleep.  In cases where the cause of insomnia is unclear or the symptoms have not improved even after a proper treatment, polysomnography can be used to help with the diagnosis.  At the most basic level, the treatment for insomnia will involve adjusting the enviroment of your bedroom appropriately, to induce a good sleep; while pharmacologic treatment is specifically reserved for people with chronic insomnia or other additional types of affliction.