From the Guidelines
To address waking up in the middle of the night, Cognitive Behavioral Therapy for Insomnia (CBT-I) is highly recommended as the first-line treatment, as it has been shown to be highly effective in improving sleep quality and reducing symptoms of insomnia, as evidenced by the 2021 study published in the Journal of Clinical Sleep Medicine 1.
Treatment Options
- Start with good sleep hygiene practices: maintain a consistent sleep schedule, create a comfortable sleep environment that's dark, quiet, and cool, and avoid screens, caffeine, and alcohol before bedtime.
- For immediate help, relaxation techniques like deep breathing or progressive muscle relaxation can help you fall back asleep, as suggested by the 2008 clinical guideline for the evaluation and management of chronic insomnia in adults 1.
- If these don't work, short-term use of over-the-counter sleep aids like melatonin (0.5-5mg taken 30 minutes before bed) might help.
- For persistent issues, prescription medications such as zolpidem (Ambien, 5-10mg), eszopiclone (Lunesta, 1-3mg), or trazodone (50-100mg) may be prescribed by a doctor for short-term use, as recommended by the 2016 clinical practice guideline from the American College of Physicians 1.
Importance of CBT-I
- CBT-I is a highly effective treatment for insomnia, with moderate-quality evidence showing improved global outcomes, including increased remission and treatment response, and reduced insomnia severity and sleep quality scores, as reported in the 2016 evidence report for a clinical practice guideline by the American College of Physicians 1.
- CBT-I addresses the underlying causes of sleep disruption, such as stress, anxiety, or disrupted sleep cycles, and is crucial for lasting improvement rather than just treating symptoms.
Additional Considerations
- The American Academy of Sleep Medicine recommends psychological and behavioral interventions, including CBT-I, as the first-line treatment for insomnia disorder, as stated in the 2021 systematic review and meta-analysis published in the Journal of Clinical Sleep Medicine 1.
- Pharmacologic treatments, such as prescription medications, may be used as a supplementary treatment for insomnia disorder, but their comparative effectiveness and long-term efficacy are not well established, as noted in the 2016 evidence report for a clinical practice guideline by the American College of Physicians 1.
From the FDA Drug Label
Eszopiclone tablets are used in adults for the treatment of a sleep problem called insomnia. Symptoms of insomnia include: trouble falling asleep, waking up often during the night Take eszopiclone tablets exactly as prescribed. Do not take more eszopiclone tablets than prescribed for you. Take eszopiclone tablets right before you get into bed.
Eszopiclone is used to treat insomnia, which includes symptoms such as waking up often during the night. To treat sleep problems that wake you in the middle of the night, take eszopiclone tablets exactly as prescribed, right before getting into bed 2.
From the Research
Treatment Options for Sleep Problems
- Melatonin supplementation is a well-tolerated alternative treatment for sleep disorders with significantly less side effects compared to currently available pharmaceutical therapies 3.
- Non-benzodiazepine hypnotics, such as eszopiclone, zolpidem, and zaleplon, are generally well tolerated and present favorable safety profiles in comparison with older benzodiazepines and barbiturates 4.
- Eszopiclone has been shown to be an efficient drug with moderate effects on sleep onset and maintenance, with no or little evidence of harm if taken as recommended 5, 6.
Sleep Timing and Consistency
- Later sleep timing and greater sleep variability are generally associated with adverse health outcomes 7.
- Regularity in sleep patterns with consistent bedtimes and wake-up times is favorably associated with health 7.
- Social jetlag is associated with adverse health outcomes, while weekend catch-up sleep is associated with better health outcomes 7.