Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills. Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills. Insomnia is a common disorder, and effective treatment can be crucial to getting the sleep you need. Explore safe, effective, nondrug insomnia treatments. By Mayo Clinic Staff. Insomnia is a common sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep. Cognitive behavioral therapy for insomnia, sometimes called CBT- I, is an effective treatment for chronic sleep problems and is usually recommended as the first line of treatment.
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Cognitive behavioral therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT- I helps you overcome the underlying causes of your sleep problems. To identify how to best treat your insomnia, your sleep therapist may have you keep a detailed sleep diary for one to two weeks. How does cognitive behavioral therapy for insomnia work?
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The cognitive part of CBT- I teaches you to recognize and change beliefs that affect your ability to sleep. This type of therapy can help you control or eliminate negative thoughts and worries that keep you awake. The behavioral part of CBT- I helps you develop good sleep habits and avoid behaviors that keep you from sleeping well. Depending on your needs, your sleep therapist may recommend some of these CBT- I techniques: Stimulus control therapy. This method helps remove factors that condition your mind to resist sleep. For example, you might be coached to set a consistent bedtime and wake time and avoid naps, use the bed only for sleep and sex, and leave the bedroom if you can't go to sleep within 2.
Sleep restriction. Lying in bed when you're awake can become a habit that leads to poor sleep. This treatment reduces the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased. Sleep hygiene. This method of therapy involves changing basic lifestyle habits that influence sleep, such as smoking or drinking too much caffeine late in the day, drinking too much alcohol, or not getting regular exercise. It also includes tips that help you sleep better, such as ways to wind down an hour or two before bedtime.
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Sleep environment improvement. This offers ways that you can create a comfortable sleep environment, such as keeping your bedroom quiet, dark and cool, not having a TV in the bedroom, and hiding the clock from view. Relaxation training. This method helps you calm your mind and body. Approaches include meditation, imagery, muscle relaxation and others.
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Remaining passively awake. Also called paradoxical intention, this involves avoiding any effort to fall asleep. Paradoxically, worrying that you can't sleep can actually keep you awake. Letting go of this worry can help you relax and make it easier to fall asleep. Biofeedback. This method allows you to observe biological signs such as heart rate and muscle tension and shows you how to adjust them. Your sleep specialist may have you take a biofeedback device home to record your daily patterns.
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This information can help identify patterns that affect sleep. The most effective treatment approach may combine several of these methods. Cognitive behavioral therapy vs. Some newer sleeping medications have been approved for longer use.
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There are many causes of insomnia, including certain anxiety symptoms. Learn more about what you can do to spot this common sleep disorder.
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But they may not be the best long- term insomnia treatment. Cognitive behavioral therapy for insomnia may be a good treatment choice if you have long- term sleep problems, you're worried about becoming dependent on sleep medications, or if medications aren't effective or cause bothersome side effects. Unlike pills, CBT- I addresses the underlying causes of insomnia rather than just relieving symptoms. But it takes time — and effort — to make it work. In some cases, a combination of sleep medication and CBT- I may be the best approach. Sept. 2. 8, 2. 01. Bonnet MH, et al.
Treatment of insomnia. Cognitive behavioral therapy for insomnia. National Sleep Foundation. Qaseem A, et al. Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians.
Annals of Internal Medicine. Trauer JM, et al. Cognitive behavioral therapy for chronic insomnia: A systematic review and meta- analysis. Annals of Internal Medicine. Brasure M, et al. Psychological and behavioral interventions for managing insomnia disorder: An evidence report for a clinical practice guideline by the American College of Physicians. Annals of Internal Medicine.
Shaughnessy AF. CBT effective for chronic insomnia. American Family Physician. Olson EJ (expert opinion). Mayo Clinic, Rochester, Minn.
Sleeping Pills & Natural Sleep Aids: What? And you may get it in the moment. But if you regularly have trouble sleeping, that’s a red flag that something’s wrong. It could be something as simple as too much caffeine or using electronics late at night.
Or it may be a symptom of an underlying medical or psychological problem. But whatever it is, it won’t be cured with sleeping pills. At best, sleeping pills are a temporary band aid. At worst, they’re an addictive crutch that can make insomnia worse in the long run. In general, sleeping pills and sleep medications are most effective when used sparingly for short- term situations, such as traveling across time zones or recovering from a medical procedure. If sleeping pills are used over the long term, they are best used only on an infrequent, “as needed” basis to avoid dependence and tolerance. Risks and side effects of prescription and over- the- counter sleeping pills.
All prescription sleeping pills have side effects, which vary depending on the specific drug, the dosage, and how long the drug lasts in your system. Common side effects include prolonged drowsiness the next day, headache, muscle aches, constipation, dry mouth, trouble concentrating, dizziness, unsteadiness, and rebound insomnia.
Other risks of sleeping pills include: Drug tolerance. You may, over a period of time, build up a tolerance to sleep aids, and you will have to take more and more for them to work, which in turn can lead to more side effects. Drug dependence. You may come to rely on sleeping pills to sleep, and will be unable to sleep or have even worse sleep without them. Prescription pills, in particular, can be very addictive, making it difficult to stop taking them.
If you stop the medication abruptly, you may have withdrawal symptoms, such as nausea, sweating and shaking. Drug interactions. Sleeping pills can interact with other medications. This can worsen side effects and sometimes be dangerous, especially with prescription painkillers and other sedatives. Rebound insomnia.
If you need to stop taking sleeping pills, sometimes the insomnia can become even worse than before. Masking an underlying problem. There may be an underlying medical or mental disorder, or even a sleep disorder, causing your insomnia that can’t be treated with sleeping pills. Some serious risks of sleeping pills. Sedative- hypnotic medications (benzodiazepines and non- benzodiazepines) can cause severe allergic reaction, facial swelling, memory lapses, hallucinations, suicidal thoughts or actions, and complex sleep- related behaviors like sleep- walking, sleep- driving (driving while not fully awake, with no memory of the event) and sleep- eating (eating in the middle of the night with no recollection, often resulting in weight- gain). If you experience any unusual sleep- related behavior, consult your doctor immediately.
Over- the- counter (OTC) sleep aids and sleeping pills. Standard over- the- counter sleeping pills rely on antihistamines as their primary active ingredient to promote drowsiness. Most use the antihistamine diphenhydramine (the key ingredient in Benadryl) or doxylamine. Common over- the- counter sleep medications include: Diphenhydramine (found in brand names like Nytol, Sominex, Sleepinal, Compoz)Doxylamine (brand names such as Unisom, Nighttime Sleep Aid)Some other OTC sleep aids combine antihistamines with the pain reliever Acetaminophen (found in brand names like Tylenol PM and Aspirin- Free Anacin PM). Others, such as Ny.
Quil, combine antihistamines with alcohol. The problem with antihistamines is that their sedating properties often last well into the next day, leading to a next- day hangover effect. When used long- term, they can also cause forgetfulness and headaches. Because of these issues, sleep experts advise against their regular use. In general, these medications act by working on receptors in the brain to slow down the nervous system.
Some medications are used more for inducing sleep, while others are used for staying asleep. Some last longer than others in your system (a longer half life), and some have a higher risk of becoming habit forming. Benzodiazepine sedative hypnotic sleeping pills. Benzodiazepines are the oldest class of sleep medications still commonly in use.
Benzodiazepines as a group are thought to have a higher risk of dependence than other insomnia sedative hypnotics. All are classified as controlled substances. Primarily used to treat anxiety disorders, benzodiazepines that have been approved to treat insomnia include estazolam (brand name Pro.
Som), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), and triazolam (Halcion). Drawbacks to benzodiazepine sleeping pills: You can become both physically and psychologically dependent on benzodiazepines. When you're on the pills for a period of time, you may believe that you can’t sleep without them, and once you stop taking them, you may actually experience physical withdrawal symptoms like anxiety and rebound insomnia. Sleeping pills can lose their effectiveness if used on a nightly basis, because the brain receptors become less sensitive to their effects. In as little as three to four weeks, benzodiazepines can become no more effective than a sugar pill. The overall quality of your sleep can be reduced, with less restorative deep sleep and dream sleep. You may experience next day cognitive slowing and drowsiness (the hangover effect), which may be even worse than the sluggishness you feel from actual sleep deprivation.
Insomnia returns once you stop, even if the medication is effective while taking it. Non- benzodiazepine sedative hypnotic sleeping pills.
Some newer medications don’t have the same chemical structure as a benzodiazepine, but act on the same area in the brain. They are thought to have fewer side effects, and less risk of dependency, but are still considered controlled substances. They include zalepon (Sonata), zolpidem (Ambien), and eszopiclone (Lunesta), which have been tested for longer- term use, up to six months. Drawbacks to non- benzodiazepine sleeping pills: Generally, non- benzodiazepines have fewer drawbacks than benzodiazepines, but that doesn’t make them suitable for everyone. Some may find this type of sleep medication ineffective at helping them sleep, while the long- term effects remain unknown. Food and Drug Administration (FDA) recently directed the manufacturers of Ambien and similar sleeping pills to lower the standard dosage due to the serious risk of morning grogginess while driving, especially in women patients. Other side effects include: Drug tolerance.
Rebound insomnia. Headaches, dizziness, nausea, difficulty swallowing or breathing.
In some cases, dangerous sleep- related behaviors such as sleep- walking, sleep- driving, and sleep- eating. New or worsening depression; suicidal thoughts or actions. Melatonin receptor agonist hypnotic sleeping pills. Ramelton (Rozerem) is the newest type of sleep medication and works by mimicking the sleep regulation hormone melatonin. It has little risk of physical dependency but still has side effects. It is used for sleep onset problems and is not effective for problems regarding staying asleep.
Ramelteon’s most common side effect is dizziness. It may also worsen symptoms of depression and should not be used by those with severe liver damage.
Antidepressants used as sleeping pills. The FDA has not approved antidepressants for the treatment of insomnia, nor has their use been proven effective in treating sleeplessness. However, some antidepressants are prescribed off- label due to their sedating effects. The FDA doesn’t regulate dietary supplements for safety, quality, effectiveness, or even truth in labeling, so it’s up to you to do your due diligence. Although the evidence is mixed, the following supplements have the most research backing them up as insomnia treatments. Valerian. Valerian is a sedating herb that has been used since the second century A.
D. It is believed to work by increasing brain levels of the calming chemical GABA. Although the use of valerian for insomnia hasn’t been extensively studied, the research shows promise and it is generally considered to be safe and non- habit forming. It works best when taken daily for two or more weeks. Melatonin. Melatonin is a naturally occurring hormone that increases at night. It is triggered by darkness and its levels remain elevated throughout the night until suppressed by the light of morning. Although melatonin does not appear to be particularly effective for treating most sleep disorders, it can help sleep problems caused by jet lag and shift work. Simple exposure to light at the right time, however, might be just as effective.
If you take melatonin, be aware that it can interfere with certain blood pressure and diabetes medications. It’s best to stick with low doses. Many people drink chamomile tea for its gentle sedative properties, although it may cause allergic reactions in those with plant or pollen allergies. To get the full sleep- promoting benefit, bring water to a boil, then add 2- 3 tea bags (or the equivalent of loose- leaf tea), cover with a lid, and brew for 1. Tryptophan. Tryptophan is a basic amino acid used in the formation of the chemical messenger serotonin, a substance in the brain that helps tell your body to sleep. L- tryptophan is a common byproduct of tryptophan, which the body can change into serotonin.
Some studies have shown that L- tryptophan can help people fall asleep faster. Results, however, have been inconsistent.
Kava. Kava has been shown to improve sleep in people with stress- related insomnia. However, kava can cause liver damage, so it isn’t recommended unless taken under close medical supervision. Other herbs that have been found to have a calming or sedating effect include lemon balm, passionflower, and lavender. Many natural sleep supplements, such as Mid. Nite and Luna, use a combination of these ingredients to promote sleep. Natural doesn't mean safe.