Treatment of Insomnia

Health encyclopaedia - Alphabetical Topic List

| A |

| B |

| C |

| D |

| E |

| F |

| G |

| H |

| I |

| J |

| K |

| L |

| M |

| N |

| O |

| P |

| Q |

| R |

| S |

| T |

| U |

| V |

| W |

| X |

| Y |

The first step of treatment is to diagnose any underlying causes, where relevant, and to treat these. For example, if insomnia is being caused by depression, then once the depression is treated, the insomnia will often disappear without further medical help.

Non-drug treatments are usually the preferred first course of action. These treatments can include:

Counselling
Cognitive behavioural therapy (altering behaviour and thinking patterns)
Referral to a clinical psychologist
Problem-solving approaches to make the patient feel in control (for example, keeping a sleep diary)
Lifestyle advice. This includes restricting caffeine, nicotine, and alcohol; taking regular exercise; keeping regular times for sleeping and waking; maintaining good sleeping environment.
Patient education about sleep and relaxation.

Drug treatment may be considered in a number of cases, either because the symptoms are particularly severe, or to alleviate short-term insomnia, or because the non-drug treatments mentioned above have failed to have an effect.

Short-acting benzodiazepines or the newer hypnotic 'Z drugs' are the current preferred drugs when drug treatment for insomnia is needed.

Z drugs are not a distinct drug group but have similar structure. Examples are Zopiclone, Zolpidem, and Zaleplon.
Benzodiazepines should only be considered where insomnia is severe, disabling, or subjecting the individual to extreme distress. All Benzodiazepines have hypnotic and anxiety-reducing (anxiolytic) effects.

There is little difference between these two groups of drugs but the individual properties suit individual cases of insomnia in different ways. Some have less addictive properties, some have less daytime effects, some work for a shorter period, and so on.

Hypnotic and anxiolytic drugs, such as temazepam, should only be used when the anticipated period of treatment is short (for example during an illness, or an overnight stay in a busy hospital ward.). Minimal effective dosage should be used and for a maximum period of one week, wherever possible.

These drugs have many side effects and it is easy for people to become dependent on them. Hypnotics lead to a kind of drug-induced hangover, with daytime drowsiness and increased chance of accidents; they also have a high incidence of dependence even after a short term course and withdrawal has adverse effects (rebound insomnia). Patients need to be warned of side effects and if the treatment is started in hospital during a short stay, it should not be automatically continued by the GP.

Other types of drugs, including barbiturates, sedative antidepressants, and antipsychotic drugs, are less preferred because of their side effects (which range from gastric irritation to high risk of addiction). These may be prescribed if other drugs are being taken or for particular types of insomnia, but are generally found to be less effective.

An alternative remedy for insomnia is valerian, a herbal medicine that has some reported positive effects but has not been exhaustively clinically investigated. Other drugs that are reputed to help are kava kava and melatonin, but neither of these are available for use in the UK.