From the Guidelines
Treatment for insomnia should begin with cognitive behavioral therapy for insomnia (CBT-I), which is considered first-line treatment. This approach includes sleep hygiene education, stimulus control, sleep restriction, relaxation techniques, and cognitive restructuring. Patients should establish consistent sleep-wake times, avoid caffeine and alcohol before bedtime, limit screen time, and create a comfortable sleep environment.
Key Components of CBT-I
- Sleep hygiene education
- Stimulus control
- Sleep restriction
- Relaxation techniques
- Cognitive restructuring If medication is necessary, short-term options include non-benzodiazepines like zolpidem (5-10mg), eszopiclone (1-3mg), or zaleplon (5-10mg) taken 30 minutes before bedtime for 2-4 weeks, as recommended by the American College of Physicians 1. Melatonin (1-5mg) may help with circadian rhythm disorders. Trazodone (25-100mg) or doxepin (3-6mg) are alternatives with less dependency risk.
Patient Education
Patient education should emphasize that medications are temporary solutions while behavioral changes provide sustainable improvement. Underlying conditions like sleep apnea, restless leg syndrome, or depression should be addressed. Insomnia often stems from hyperarousal of the brain's wake-promoting systems, and CBT-I helps retrain the brain to associate the bed with sleep rather than wakefulness. Regular follow-up is essential to monitor treatment effectiveness and adjust as needed, as suggested by the American Academy of Sleep Medicine 1. The most recent guidelines from the American Academy of Sleep Medicine (2021) support the use of CBT-I as the first-line treatment for insomnia, with a strong recommendation based on high-quality evidence 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Insomnia
- Nonpharmacologic treatments for insomnia, such as cognitive-behavioral therapy, stimulus-control therapy, relaxation, paradoxical intention, and sleep restriction, are efficacious treatments that mental health practitioners can consider in the treatment of insomnia 2, 3.
- Cognitive-behavioral therapies have emerged as the treatment of choice for chronic insomnia, targeting behavioral, cognitive, and conditioning factors underlying insomnia, thereby restoring normal sleep-wake functioning 3.
- 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 4.
- CBT-I encompasses psychoeducation about sleep and sleep hygiene, relaxation techniques, specific behavioral techniques like stimulus control or sleep restriction, and cognitive techniques to reduce nocturnal ruminations 4, 5.
Patient Education Regarding Sleep Hygiene
- Patient education regarding sleep hygiene is an essential component of CBT-I, aiming to address the perpetuating factors that contribute to the development of chronic insomnia 4, 5.
- Sleep hygiene education includes techniques such as progressive muscle relaxation, stimulus control, and sleep restriction, which can be used to improve sleep quality and reduce symptoms of insomnia 5.
- Educating patients about sleep hygiene and providing them with techniques to manage their insomnia can lead to sustained improvements in sleep parameters over time 2, 3.