The best treatment for insomnia depends on what is causing the problem. For example, if the problem is a result of depression or anxiety, then the best treatment is psychotherapy or medication, such as an antidepressant or anti anxiety drug. In addition, it is important to determine whether another sleep disorder, such as sleep apnea or restless legs syndrome, is causing you to have problems falling asleep. What feels like insomnia to you may actually be another problem. If this is the case, treating the actual sleep disorder will cure the problem.

If your insomnia is not caused by depression, anxiety, or another sleep disorder but involves some other disturbance of your normal sleep routine, there are two primary options.

MEDICATION. Many people try medication for insomnia. Some of the more common ones are Ambien and Sonata. A newer choice is Estorra, with several other sleeping medications about to be sold in the United States. These medications have been found to have few negative effects, and recent studies indicate little tolerance over long periods, whereas in the past, it was recommended that sleeping medications not be taken for more than two to three weeks. Drugs to help you sleep at night may not always be a good long-term solution, however drugs are not always the answer.

STANDARD TREATMENT FOR INSOMNIA. Research has shown that standard cognitive-behavior therapy is the most effective treatment for insomnia. Study after study has shown that if you diligently follow the seven rules outlined in the box below, you can successfully fall sleep and stay asleep.

In addition, there are other things that you can try to help you sleep better.

• Relaxation. Research has shown that relaxation training is effective in 45 percent of cases. You can learn to relax using a number of different techniques, including progressive muscle relaxation, guided imagery, and meditation. Several methods are covered in Chapter 9. There are also several good books available to teach you ways to relax.
• Hot bath. A twenty-minute hot bath taken an hour or two before bedtime can often help you to sleep. The hot bath affects body temperature, which makes you tired and helps to prolong deeper natural sleep. Be careful about hot baths if you have any circulatory disorders. If this is the case, consult your physician first.
• Keep a strict sleep schedule. It is best to maintain a strict sleep schedule in which you go to bed at the same time every night and wake up at the same time every morning.
• Don’t stay in bed too long. One problem that people often have is staying in bed too long. Don’t stay in bed nine or ten hours if you need only eight hours of sleep. It is better to be in bed only the exact number of hours that you need sleep. This is called sleep restriction. It will consolidate your sleep, especially if you have long periods of being awake in the middle of the night or wake too early in the morning. To do this, you will need to keep a sleep diary to determine how much you actually sleep. Many people believe that they, sleep less than they actually do. By keeping a sleep diary for two weeks you can figure out the average amount of time you sleep per night. Then for the first five to seven days limit the time you are in bed each night to the average number of hours that you actually slept for the past two weeks. Once you are sleeping the entire time that you are in bed, gradually increase the amount of time that you allow yourself to sleep. Increase this time by small amounts, anywhere from fifteen to thirty minutes. This method will help consolidate your sleep and will help you associate your bed with sleep. This process can take from a few days to several months to accomplish. The one side effect that you need to be aware of is that you may be sleepy during the day from the initial sleep deprivation.
• Reduce alcohol and drug use. Alcohol and drugs interfere with sleep. For someone with a drug or alcohol problem, withdrawal can occur in the middle of the night, causing the person to wake. Reducing or eliminating alcohol and drug use is beneficial to combating insomnia.
• Watch the clock and stay up as long as possible. Some people get caught in a vicious cycle of trying without success to fall asleep and then becoming frantic. Being frantic does not help falling asleep. If this is true for you, simply watching the clock and trying to stay awake as long as possible will break this pattern. Do this for a few nights in a row, and you will learn that you can still function the next day with less sleep than you would want. You will also decrease the worry when you can’t fall asleep on other nights. This suggestion, while it seems to counter all the other advice provided in this book, can be helpful for some, but it may not work for all.

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