The goal of treatment for insomnia, set by your doctor, includes improving the quantity and quality of sleep, reduction of the stress and anxiety that is associated with insufficient sleep, as well as an improvement in daytime functioning. Treatment usually involves a combination of cognitive behavioural therapy and/or medication.1,2
Cognitive behavioural therapy for insomnia (CBT-I)1,2
CBT-I can help you control or eliminate negative thoughts and actions that keep you awake.2
The cognitive part of CBT-I teaches you to recognise and change beliefs that affect your ability to sleep. It can help you control the negative thoughts and worries that keep you up at night. The behavioural part helps you develop good sleep habits and avoid behaviours that cause sleep problems. Examples include sleep hygiene education, relaxation therapy, stimulus-control therapy and sleep-restriction therapy2
Sleep hygiene recommendations include1:
- Reduce alcohol, nicotine and caffeine intake before bedtime
- Avoid rich or fatty and spicy foods before bedtime
- Exercise regularly but not close to bedtime
- Avoid drinking large volumes of fluid (like water) before bedtime
- Bedrooms should be well ventilated, quiet and dark
- Use dim lights in the bathroom as bright light can make it difficult to go back to sleep
- Remove your bedroom clock from sight
Stimulus-control therapy helps remove factors that condition your mind to resist sleep. This could include being coached to set a consistent bedtime and wake time and avoid naps, use the bed only for sleep and intimacy, and leave the bedroom if you don’t fall asleep within 20 minutes, only returning when you are sleepy.2
Relaxation techniques involve you learning to relax your muscles and practicing breathing exercises to reduce anxiety at bedtime.2 Learn more about how to manage your insomnia
Medicines used to treat insomnia1,2
These are prescribed by your doctor to help you2,3,4:
- Get to/fall asleep if you have sleep onset insomnia (take more than 30 minutes to fall asleep)
- Stay asleep if you have sleep maintenance insomnia (spend 30 minutes or more awake during the night)
- Fall asleep and stay asleep if you struggle with mixed insomnia (sleep onset insomnia plus sleep maintenance insomnia)
Prescription sleeping pills include benzodiazepines, non-benzodiazepines and melatonin receptor agonists, and are usually only prescribed for short-term use (few weeks). They can have side effects e.g. daytime grogginess, increase the risk of falling, or they can be habit-forming.2,5
Non-prescription medicines/products that claim to relieve insomnia may be helpful if you occasionally have trouble falling asleep, but they are not intended for regular use or for the treatment of chronic insomnia.2,5
Your doctor can talk to you about the potential benefits of each medicine (e.g. which symptom of insomnia it will treat, improved daytime symptoms and function) as well as the risks (e.g. bothersome side effects and the potential for dependence).5
Alcohol and sleep1,5
People often use alcohol as a sleep aid. While it may help you fall asleep more quickly, alcohol interferes with sleep later in the night. You may experience periods of wakefulness and/or nightmares when the alcohol wears off during the night.1,5
Breathing from your stomach (belly) rather than your chest can activate the relaxation response and lower your heart rate, blood pressure, and stress levels to help you drift off to sleep.6
- Lay down in bed and close your eyes.
- Put one hand on your chest and the other on your stomach.
- Breathe in through your nose. The hand on your stomach should rise. The hand on your chest should move very little.
- Exhale through your mouth, pushing out as much air as you can while contracting your abdominal (stomach) muscles. The hand on your stomach should move in as you exhale, but your other hand should move very little.
- Continue to breathe in through your nose and out through your mouth. Try to inhale enough so that your lower abdomen rises and falls. Count slowly as you exhale.
Chigome AK, Nhira S, Meyer JC. An overview of insomnia and its management. S Afr Pharm J 2018;85(2):32-38.
Insomnia. Diagnosis and treatment. Mayo Clinic. Available online at https://www.mayoclinic.org/diseases-conditions/insomnia/diagnosis-treatment/drc-20355173. [Accessed 16 September 2022].
Suni E. What are the different types of insomnia? 24 June 2022. Sleep Foundation. Available online at https://www.sleepfoundation.org/insomnia/types-of-insomnia. [Accessed 16 September 2022].
Bonnet MH. Evaluation and diagnosis of insomnia in adults. 18 June 2021. UpToDate. Available online at https://www.uptodate.com/contents/evaluation-and-diagnosis-of-insomnia-in-adults. [Accessed 16 September 2022].
Martin JL, Neubauer DN. Patient education: Insomnia treatments (Beyond the basics). 30 January 2022. UpToDate. Available online at https://www.uptodate.com/contents/insomnia-treatments-beyond-the-basics. [Accessed 16 September 2022].
Smith M, Robinson L, Segal R. How to sleep better. 31 August 2022. HelpGuide. Available online at https://www.helpguide.org/articles/sleep/getting-better-sleep.htm. [Accessed 16 September 2022].