From the Guidelines
To treat issues with staying asleep, cognitive behavioral therapy for insomnia (CBT-I) is highly recommended as the first-line treatment, as it has been shown to be highly effective for long-term improvement without medication side effects. Establishing a consistent sleep schedule by going to bed and waking up at the same time every day, even on weekends, is also crucial. Creating a relaxing bedtime routine that includes activities like reading, taking a warm bath, or practicing relaxation techniques such as deep breathing or meditation can help improve sleep quality. Making the bedroom conducive to sleep by keeping it dark, quiet, cool (around 65°F), and comfortable is also essential.
Some key points to consider:
- Avoid electronic devices at least one hour before bedtime as the blue light can interfere with melatonin production 1.
- Limit caffeine after noon and avoid alcohol close to bedtime, as it may help you fall asleep but disrupts deeper sleep stages.
- If you wake during the night, avoid checking the time as this can increase anxiety.
- For short-term insomnia, over-the-counter options like melatonin (0.5-5mg taken 1-2 hours before bedtime) may help, but prescription medications such as zolpidem (Ambien, 5-10mg), eszopiclone (Lunesta, 1-3mg), or trazodone (50-100mg) should only be used under medical supervision due to potential side effects and risk of dependence 1.
- Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be highly effective for long-term improvement without medication side effects, and should be considered as the first-line treatment 1.
It's also important to note that if sleep problems persist despite these measures, consulting a healthcare provider to rule out underlying conditions like sleep apnea or restless leg syndrome is necessary.
From the Research
Treatment Options for Staying Asleep Issues
- Cognitive Behavioral Therapy for Insomnia (CBT-I) is a multi-component treatment that targets difficulties with initiating and/or maintaining sleep, and is delivered over the course of six to eight sessions 2.
- The primary focus of CBT-I is to address the perpetuating factors that contribute to the development of chronic insomnia, and its core components include Sleep Restriction Therapy, Stimulus Control Therapy, Sleep Hygiene, and Cognitive Therapy 2, 3.
- CBT-I has been found to be an effective alternative to pharmacotherapy for individuals with insomnia, and can produce results that are equivalent to sleep medication, with no side effects, fewer episodes of relapse, and a tendency for sleep to continue to improve long past the end of treatment 3, 4.
Pharmacological Interventions
- Trazodone, a sedative antidepressant, has been found to improve the results of CBT for primary insomnia in non-depressed patients, particularly in increasing slow wave sleep duration 5.
- However, the use of benzodiazepines and non-benzodiazepine receptor agonists (non-BzRAs) is discouraged in the geriatric population, especially for long-term use, due to their potential side effects such as dementia, serious injury, and fractures 6.
- Ramelteon, a melatonin receptor agonist, has a minimal adverse effect profile and is effective for sleep-onset latency and increased total sleep time, making it a valuable first-line option for older adults 6.
Non-Pharmacological Interventions
- Cognitive behavioral therapy should always be the first line treatment for insomnia, and non-pharmacologic interventions such as sleep hygiene and relaxation techniques should be emphasized 3, 6.
- Treating comorbid conditions and focusing therapy on using benzodiazepines and non-BzRAs as last resorts is also recommended 6.