Insomnia Therapies and Treatments

Healthy Sleep Habits for Insomnia

• A consistent sleep routine: Try going to bed and waking up around the same time daily. Go to bed around eight hours before you would normally start your day. 
• Avoid caffeine or alcohol in the evenings: These stimulants make it harder to fall asleep or stay asleep. Alcohol might help you fall asleep more easily but doesn’t allow for restful sleep.
• Eat healthier: Certain foods promote sleep, like cherries and nuts. Try including these in your diet. Additionally, avoid eating two hours before bedtime. 
• Develop calming routines: A bedtime routine that helps reduce stress is crucial if stress keeps you up at night. This might involve reading before bed, having a hot water bath or giving yourself a gentle head massage. 
• Avoid screens two hours before bedtime: The light from gadgets has the potential to hinder your sleep-wake cycle. Keep your screens away well before bedtime. 
• Exercise right: Consistent exercise helps you feel more tired by the end of the day but exercising two hours before bedtime might contribute to insomnia. Ensure to exercise regularly but at least two hours before going to bed. 
• Create a sleep-conducive environment: Keep your bedroom dark, quiet and at a comfortable temperature so your body relaxes and drifts into sleep easier. 

Cognitive Behavioural Therapy for Insomnia (CBT-I)

1. Sleep Restriction Therapy: It aims to reduce the amount of time we spend in bed trying to make up for “lost” sleep. Restricting the amount one spends trying to sleep helps increase homeostatic sleep drive. When someone spends a lot of time lying in bed trying to sleep but not actually sleeping, sleep restriction therapy attempts to match the time someone spends in bed to the time someone spends in bed sleeping as closely as possible. To help determine the same, your doctor might ask you to maintain a sleep journal.
2. Stimulus Control Therapy: Based on behaviour, this component of CBT-I aims to change conditioning history, helping one associate stimuli (like the bed and bedroom) with sleep. People often associate their bed and bedroom with wakefulness if they tend to use their bed for other activities apart from sleep and sex, like reading or watching television. Stimulus control recommends that people with insomnia go to bed only when they’re feeling sleepy, avoid using the bed for other activities apart from sleep or sex, get out of bed if they do not fall asleep in 10-15 minutes and get up at more or less the same time every day. 
3. Sleep hygiene: This revolves around educating a patient about better sleep practices that promote sleep. It involves modifications to everyday life that might help you fall or stay asleep more consistently. It’s usually most helpful when customised for a patient’s particular needs and sleep cycle. It involves suggestions like avoiding caffeine before bed or exercising regularly. 
4. Cognitive therapy: This aspect of CBT-I focuses on setting realistic sleep expectations. It involves identifying thoughts that might be contributing to wakefulness and modifying them. A doctor might also help you recognise your emotional response to these thoughts. 

Prescription Medication for Insomnia

• Zolpidem: Commonly known as Ambien, and usually used for short-term treatment of insomnia, zolpidem comes with adverse effects like diarrhoea, nausea or dizziness. 
• Eszopiclone: Though the means of action is still unknown, common side effects include drowsiness, nausea, headaches and migraines. 
• Zaleplon: Used for short periods of time to treat insomnia, side effects include abdominal pain, nausea, dizziness, eye pain and dysmenorrhea. 
• Triazolam: Used mainly to treat insomnia in adults, side effects include nervousness, headaches, lightheadedness and drowsiness. 
• Temazepam: Used as a short-term treatment for insomnia, side effects include hypotension, blurred vision and excessive sleepiness. 
• Ramelteon: A melatonin receptor agonist, ramelteon’s side effects include fatigue, nausea and dizziness. 
• Quazepam: Used as a short-term treatment for insomnia, side effects include dry mouth, fatigue and headaches. 
• Suvorexant: Mainly used to treat insomnia in adults, side effects include abnormal dreams, dry mouth and diarrhoea. 

Natural Sleeping Aids

• Melatonin: A natural sleep-regulating hormone produced in the pineal gland in the brain, melatonin helps maintain one’s circadian rhythm. Sometimes, melatonin production might decrease due to exposure to night lights, diseases and various other reasons. Melatonin supplements can help someone fix their sleep-wake cycle, in the short term. Do note that melatonin comes with side effects like nausea, headaches and stomach cramps. 
• Cannabis: Cannabis contains cannabinoids, the two best known being tetrahydrocannabinol (THC) and cannabidiol (CBD). Cannabinoids closely resemble endocannabinoids, naturally occurring compounds in the human body that interact with receptors to affect various systems and processes. The entire system is called the endocannabinoid system. The endocannabinoid system is responsible for regulating a range of physiological processes, including sleep. Cannabinoids interact with receptors in the endocannabinoid system similar to the way endocannabinoids do, promoting sleep and tackling the symptoms of insomnia. Latest research demonstrates that cannabinoids help in naturally restoring the body’s melatonin production.
• Magnesium: Research suggests that magnesium can influence the quality and quantity of sleep. Magnesium can be obtained from various foods like nuts, fruits, beans and whole grains. If you are afflicted by kidney issues, consume magnesium supplements cautiously. 

Alternative Insomnia Therapies

• Acupuncture: Becoming more popular to treat insomnia, acupuncture is thought to be a safe adjunct therapy. While studies show its efficacy, further research is needed to determine its effectiveness for insomnia. 
• Yoga: Research shows a correlation between yoga and improved quality as well as quantity of sleep. While yoga improves sleep for everyone, adult women, pregnant women, and elderly people could benefit from yoga particularly. 
• Meditation: Mindfulness meditations, especially for insomnia caused by racing thoughts, can be effective in treating insomnia. With increasing research backing meditation practices to tackle sleepless nights, it is a possible alternative to getting restful sleep. 

Choosing the Right Treatment

• What is Insomnia?
• The Relationship Between Sleep and Health