Once properly diagnosed, insomnia may be treated in a number of ways, all of which depend on the type of insomnia. The typical treatment for sleeping problems tends to be the prescription of sleeping pills. A 2005 study found that adults aged twenty to forty-four doubled their use of prescription sleep aids, while among adolescents aged ten to nineteen, the increase in usage was 85 percent between 2000 and 2004. The treatment of transient insomnia may involve small doses of a short-acting drug, including benzodiazepines such as diazepam (Valium) or lorazepam (Ativan); Z-drugs such as zaleplon (Sonata), zolpidem (Ambien), and zopiclone (eszopiclone analogue Lunesta); or nonbenzodiazepines, such as indiplon. Simply counseling or educating patients concerning situations that may increase their sleep problems is frequently found to be effective. If the transient insomnia is caused by disruptive sounds in the sleeping environment (such as snoring or traffic noise), devices that mask the noise may be used. Using earplugs and placing a fan in the room to mask the noise are two simple examples of this method. If the sleep disturbance is associated with misaligned circadian rhythms, the person’s bedtime may be systematically adjusted toward either an earlier or a later hour, depending on what time the individual normally goes to sleep. Strict adherence to the adjusted sleep-wake schedule is then necessary for the individual to remain on a regular schedule. This method is referred to as chronotherapy.
Peter Hauri suggests that treatment of persistent psychophysiological insomnia should typically involve aspects of three domains: sleep hygiene, behavioral treatment, and the use of hypnotics. Methods involving sleep hygiene focus on educating the patient concerning proper sleep habits. Hauri states that the goal is for the patient to avoid all stimulating or arousing thoughts. This is done by focusing on or engaging in monotonous or nonstimulating behaviors at bedtime such as reading or listening to pleasant music.
Behavioral methods include performing relaxation therapy, limiting sleep time to a few hours per night until the patient is able to use the time in bed as true sleeping time, and using stimulus control therapy. This method requires patients to get out of bed whenever they are not able to sleep. The process is aimed at reducing the association between the bedroom and the frustration with trying to go to sleep. Auricular acupuncture also has been found successful in the treatment of insomnia.
The use of hypnotic medications is indicated in patients who have such a need for sleep that they “try too hard” and thus become aroused by their efforts. In 2005, the Food and Drug Administration approved ramelteon (Rozerem) for the treatment of long-term insomnia. As with transient insomnia, a small dose of a short-acting drug is suggested to break this cycle of frustration.
The treatment for patients who exhibit no objective polysomnographic findings is similar to that for patients with any other type of insomnia. These patients also tend to respond to behavioral, educational, and pharmacological methods.