Effective treatment for insomnia combines behavioral strategies and, in some cases, medical interventions to help improve sleep quality and duration.

1. Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I is usually the first-line treatment for chronic insomnia. It is a 6- to 8-week program designed to help you fall asleep faster and stay asleep longer. Research shows that 70 percent to 80 percent of people with insomnia experience significant improvement after four to six sessions of CBT-I, with benefits often lasting for months or even years. CBT-I includes:

Cognitive Therapy: Reduces anxiety about not being able to sleep.
Relaxation Therapy: Uses relaxation techniques to help you fall asleep more easily.
Sleep Education: Promotes healthy sleep habits.
Sleep Restriction Therapy: Limits time in bed to improve sleep efficiency and gradually increases it as sleep improves.
Stimulus Control Therapy: Strengthens the association between bed and sleep by encouraging you to go to bed only when sleepy, leave the bed if unable to sleep, and use the bed only for sleep.

2. Medications

The prescription medications for treating insomnia include:

Benzodiazepine Receptor Agonists: These medicines help with sleep but may cause anxiety, dizziness, confusion, or muscle weakness. Rarely, they can trigger severe allergic reactions or activities while asleep, such as walking, eating, or driving. They can be habit-forming and are usually prescribed for short-term use.
Melatonin Receptor Agonists: These medicines can improve sleep but may cause dizziness and fatigue. Rarely, they may cause sleep-related activities or severe allergic reactions.
Orexin Receptor Antagonists: These medicines are effective for insomnia but not recommended for people with narcolepsy. Rare side effects include sleep-related activities or temporary inability to move or speak when falling asleep or waking.
Benzodiazepines: These medicines are prescribed only if other treatments fail. They carry risks of dizziness, confusion, muscle weakness, dangerous drug interactions, and dependence, so use is typically limited to a few weeks.

Sometimes, doctors prescribe medications not specifically approved by the Food and Drug Administration (FDA) for insomnia, such as certain antidepressants, antipsychotics, or anticonvulsants, to help improve sleep.

3. Over-the-Counter Sleep Aids

They include over-the-counter medications and dietary supplements. However, it is important to pay close attention to potential risks and side effects.

Melatonin Supplement: Melatonin is a natural hormone released by the brain about four hours before sleep, triggered by reduced light exposure at night. Melatonin supplements are available over the counter in pill form. Since these supplements are unregulated by the FDA, dosages and ingredients can vary between brands, so it’s recommended to stick with a single trusted brand and avoid unknown sources. However, long-term use of melatonin supplements for sleep may pose potential health risks, such as heart failure. It’s better to adopt a healthy lifestyle or use other approaches that target the root cause.
5‑Hydroxytryptophan (5‑HTP) Supplement: Disruptions in the gut microbiome can interfere with the production of neurotransmitters and hormones—particularly serotonin and melatonin—which are essential for regulating the sleep-wake cycle. A 2024 study found that 5-HTP supplementation can enhance certain aspects of sleep quality in older adults, especially in those with poor sleep, and may also improve gut microbiota composition.
Sleep Medications With Antihistamines: Diphenhydramine and doxylamine succinate are sedating antihistamines found in many over-the-counter sleep and allergy medications. They promote sleep by reducing histamine levels in the brain and helping the body feel ready for rest.

4. Light Therapy

Light therapy uses light exposure to adjust your circadian rhythm, especially if you tend to sleep and wake earlier than desired. Treatment may involve using a lightbox or spending time outdoors in the evening.

5. Vagus Nerve Stimulation

Vagus nerve stimulation activates the parasympathetic “rest and digest” response and reduces sympathetic overactivity, influencing brain regions that regulate stress and the sleep-wake cycle. it can also modulate key sleep-related neurotransmitters such as GABA and serotonin and enhance deep sleep brain waves. Vagus nerve stimulation can be performed either mechanically with devices or naturally. Nondevice methods such as diaphragmatic (belly) breathing offer similar benefits; by slowing the breath and lowering stress hormones, this technique triggers relaxation and improves sleep. A 2021 study showed that four weeks of diaphragmatic breathing can increase sleep duration, reduce disturbances, and enhance overall sleep quality and daytime functioning.

6. Acupuncture

Acupuncture may be particularly beneficial for people whose insomnia is related to depression, menopause, or chronic pain. Regular treatments over one to two months can improve sleep quality, reduce nighttime awakenings, increase total sleep time, decrease anxiety, and alleviate pain.

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