Counting on researched sleep training techniques may be more effective than counting sheep to treat long-term insomnia.
To be diagnosed with chronic insomnia, you must have experienced impaired sleep for three or more nights a week for over 3 months. Daytime effects are also considered, including:
- sleepiness and fatigue
- memory lapses
You can unlearn even chronic insomnia. Cognitive behavioral therapy, sleep retraining, and medication may be key to your sleep reboot.
CBT, a type of talk therapy, addresses thought patterns affecting behavior.
Usually, CBT requires at least 4-8 sessions.
As a part of CBT, or on its own,
Visualizing times when you’ve functioned OK after a sleepless night may help stop excess worry.
A therapist may also suggest bedtime yoga and deep breathing techniques.
Just like Pavlov’s dog theory, that living things can be conditioned to elicit a response to a given stimulus with time and repetition, a brain experiencing insomnia and the negative feelings associated with it might be conditioned to start feeling anxious, irritable, or glum come bedtime.
An expert may advise you to:
- Keep a sleep journal.
- Go to sleep and wake up at the same time each day.
- Get out of bed for 5-10 minutes if you’re sleepless at night.
- Monitor sleep efficiency. If you only sleep 6 out of the 8 hours you’re in bed, try reducing your in-bed time to 6 hours. When you sleep the full time you’re in bed, you can try adding 15 minutes in progressive intervals until your in bed, asleep for a full 8 hours.
Paradoxical intention is a fancy term for reverse psychology.
- If trying to sleep has you wide awake with panic, trying to stay awake may reverse the process.
- Yawning? Good! Forcing yourself to stay alert can paradoxically reawaken your craving for sleep.
A doctor may recommend medications as a supplemental treatment.
Benzodiazepines and non-benzodiazepines
The naturally occurring chemical gamma-aminobutyric acid (GABA) turns your brain’s motor off to sleep. But when your brain stops releasing GABA, benzodiazepines and nonbenzodiazepines (BZRAs) can help.
Until the 1990s, benzodiazepines were the only FDA-approved drugs to treat insomnia. These medications include:
- estazolam (ProSom)
- temazepam (Restoril)
- quazepam (Doral)
While benzodiazepines are thought to be effective, they come with potential risks (which you’ll want to discuss with a doctor), including:
- impaired memory
- daytime sleepiness
- building up a tolerance after 4 weeks
- severe respiratory problems, particularly if you’re older
- complications with coexisting conditions such as COVID-19, according to this
2022 literature review
Nonbenzodiazepine BZRAs were FDA approved in the 1990s. These medications include:
- zolpidem (Ambien) — for help falling asleep
- eszopiclone (Lunesta) — for falling asleep and staying asleep
- zaleplon (Sonata) — for falling asleep
Nonbenzodiazepine BZRAs may have fewer side effects than their predecessors, but they still present risks, including:
- trying to drive while asleep (a symptom of complex sleep-related behaviors)
- dependence and rebound insomnia
- Waking up at night is common with depression.
- Some antidepressants such as fluoxetine may help with depression symptoms but do interrupt sleep.
- Others such as doxepin may improve sleep, but cause too much sleepiness to be beneficial long term. To balance depression and insomnia treatments, you might try taking a low dose, and not too close to sleep time.
Trazodone is presently the gold standard antidepressant given for sleep.
Other sleep medication
A dual orexin receptor antagonist (DORA) blocks orexin, the neurotransmitter that tells your brain to wake up. The FDA approved two types of DORAS for helping adults with insomnia:
In January 2022, the FDA approved a new insomnia drug, Quivivig, similar to Dayvigo, that promotes better sleep with less grogginess the next day.
Over-the-counter (OTC) medications and supplements
OTC medical treatments for insomnia include:
- Antihistamines like:
- diphenhydramine (ZzzQuil)
- doxylamine (Unisom)
- Melatonin, a natural hormone, may be helpful as a supplement if your sleep schedule has been disrupted.
- Valerian root may help with relaxation.
Making your bedroom into a sanctuary
You can rework your bedroom to create an atmosphere of undivided attention to sleep by keeping it:
Practicing relaxation techniques
Mindfulness techniques that can soothe you at bedtime, include
- guided sleep meditation
- progressive muscle relaxation
- deep breathing
- positive visualization
Stressing about work instead of dozing off? Why not leave your worries on the page? Journaling can relieve stress.
Avoiding alcohol toward bedtime
There are links to alcohol fueling insomnia. It’s a sound idea to avoid drinking leading up to bedtime. Plus, part of using insomnia medications only as prescribed involves steering from alcohol since mixing it with sedatives may cause over-sedation or overdose.
Including sex might be helpful. In a
A series of sleepless nights can condition you to dread sleeplessness. Trying to sleep can become a fruitless effort and chronic insomnia may develop.
Cognitive behavioral therapy, sleep education, medication, and sleep hygiene strategies really can help.