Insomnia – Diagnosis and Treatment

Diagnosis

Depending on your circumstances, the diagnosis and search for the cause of insomnia may include:

Examen in person Your doctor may perform a physical exam to determine the source of your insomnia. Sometimes, your doctor may order a blood test to rule out thyroid problems and other conditions that could be causing poor sleep.
Review of sleep habits Your doctor might ask you questions about your sleep habits and give you a questionnaire to assess your daytime sleepiness. A sleep diary may be requested for a few weeks.
Sleep study. You may need to spend the night in a sleep center if you are unsure about the reason for your insomnia. To monitor and record various body activities during sleep, such as brain waves, breathing and heartbeat, and to track and record body movements, tests are performed.

Treatment

Many people can get restful sleep by changing their sleep habits and treating any medical conditions, stress or medication that could be causing it. Your doctor may recommend medication, cognitive behavioral therapy or both to improve relaxation and sleep.

Cognitive behavioral therapy for sleeplessness

Cognitive behavioral therapy for sleeplessness (CBT-I), which can help you control and eliminate your negative thoughts and actions, is recommended for those suffering from insomnia. CBT-I can be as effective or even more effective than sleeping pills.

CBT-I’s cognitive component teaches you how to identify and change your sleep habits. This can help you to control your negative thoughts and worries, or even eliminate them altogether. You may also need to stop worrying so much about falling asleep that you don’t get enough sleep.

The behavioral component of CBT-I assists you in developing good sleep habits and avoiding bad sleeping habits. Some strategies include:

Stimulus control therapy. This helps to remove any factors that make it difficult for you to fall asleep. You might be instructed to have a set bedtime and wake-up time, avoid naps, and use the bedroom only for sleep. If you are unable to go to sleep in 20 minutes, leave the room and return when you feel sleepy.
Relaxation techniques. You can reduce anxiety at night by using biofeedback, progressive muscle relaxation and breathing exercises. These techniques will help you relax by controlling your heart rate, breathing, and muscle tension.
Restriction on sleeping. This therapy reduces your time in bed and prevents you from taking naps during the day. It also causes partial sleep deprivation which can make you tireder the next morning. Your time in bed can be gradually increased once your sleep quality has improved.
Staying awake and passive. This therapy is also known as paradoxical intention. It’s a treatment for learned insomnia that aims to reduce anxiety and worry about falling asleep.
Light therapy. You can use light to reset your internal clock if you fall asleep too quickly and wake up too soon. You can either go outside during the day or use a light box. Discuss your options with your doctor.

To help you get sound sleep and alertness during the day, your doctor might recommend other strategies.

Prescription medication

Prescription sleeping pills are able to help you fall asleep, stay asleep, or both. While prescription sleeping pills are not recommended for use for longer than a few weeks by doctors, there are many medications that can be used for long-term.

Examples include:

Eszopiclone, (Lunesta).
Ramelteon (Rozerem)
Zaleplon (Sonata)
Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist)

Side effects of prescription sleeping pills include daytime grogginess, increased risk of falling, and habit-forming. Talk to your doctor about possible side effects.

Sleep aids that are over-the-counter

Nonprescription sleep medication contains antihistamines which can cause you to feel drowsy. However, they are not recommended for daily use. These antihistamines can cause side effects such as dizziness, confusion, dizziness, cognitive decline, difficulty urinating, and daytime sleepiness.

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Clinical trials

Mayo Clinic studies are available to help you prevent, detect, treat, or manage this condition.

Lifestyle and home remedies

Insomnia can be treated regardless of your age. Changes to your daily routine and how you sleep at night are often the key to insomnia treatment. These tips might help.

These are some basic tips

Follow a sleeping schedule. Your bedtime and your wake time should be the same every day, even on weekends.
Keep active. Regular exercise promotes a good night of sleep. Avoid stimulating activities at night and exercise at least 30 minutes before bed.
Take a look at your medication. Check with your doctor if you are taking medication regularly to determine if they might be contributing to your insomnia. Check the label of OTC products for caffeine and other stimulants such as pseudoephedrine.
Limit or avoid naps It can be difficult to fall asleep at night if you take naps. You may find it difficult to fall asleep at night without a nap.
Limit or avoid caffeine, alcohol, and nicotine. These can all make it difficult to fall asleep and can persist for hours.
Do not suffer from pain. Talk to your doctor if you have a painful condition. They may be able to prescribe pain relief medications that can be used while you sleep.
Avoid eating large meals or drinking before going to bed. Light snacks are fine, and can help to avoid heartburn. You will not need to urinate as frequently if you drink less before bedtime.

Bedtime

Your bedroom should be comfortable for sleeping. Your bedroom should only be used for sleeping or sex. It should be dark, quiet, and at a comfortable temperature. You can hide all clocks, including those on your wristwatch or cellphone, in your bedroom so that you don’t have to worry about the time.
Relax. When you go to bed, forget about worrying and planning. Warm baths or massages before bed can be helpful in getting you ready for sleep. You can create a relaxing bedtime ritual by taking a warm bath, reading, listening to soft music, doing breathing exercises, or even praying.
Do not try to get too much sleep. You’ll be more awake the harder you try. You can read in another room until your eyes are very tired. Then, go to bed. Do not go to bed before you are tired.
If you aren’t sleeping, get out of bed. Get as much sleep as you can, then get up and leave the bed. If you aren’t sleeping, don’t stay in your bed.

Alternative medicine

Many people don’t visit their doctor to treat insomnia. They try to manage their sleeplessness by themselves. Some people resort to:

Melatonin. The OTC supplement is advertised as a remedy for insomnia. While it is safe to use melatonin for only a few weeks at a time, there is no evidence to support its effectiveness as a treatment for insomnia.
Valerian. Although it is a dietary supplement, it is often sold as a sleep aid due to its mild sedating effects. Before you try valerian, talk to your doctor. People who used valerian in high doses or for long periods of time may have suffered liver damage. However, it is not known if the cause of the damage was valerian.
Acupuncture. Although there is some evidence that acupuncture can be helpful for those suffering from insomnia, more research is necessary. Ask your doctor if acupuncture is something you would like to try in addition to your regular treatment.
Yoga or Tai Chi. Research suggests that regular yoga and tai-chi practice can improve your sleep quality.
Meditation. A few small studies have shown that meditation can help with stress reduction and sleep quality.

Be aware of herbal and dietary sleep aids

The Food and Drug Administration doesn’t require manufacturers to show proof of safety or effectiveness before marketing dietary supplement sleeping aids. Talk with your doctor before you take any herbal supplements. If you are taking certain medications, some products may be dangerous or cause harm.

Prepare for your appointment

Talking to your primary doctor is the best way to start if you have sleep problems. Ask your primary care doctor if you have any questions. If possible, bring your partner. Talk to your doctor about how much you sleep and how well.

What you can do

Make a list of the following items to prepare for your appointment:

Any symptoms you’re experiencing, Include any other information that might seem unrelated to your appointment.
Information about you Including new or ongoing health issues, major stressors or recent life changes.
All medications You should inform your doctor about any prescriptions, over-the-counter medicines, vitamins, or herbal supplements you are taking. Tell your doctor about any medications you have taken to help you fall asleep.
Questions to ask Your doctor should make every effort to maximize your time at the appointment.

The following are some basic questions you can ask your doctor:

What could be causing my insomnia?
Which treatment is the best?
These are my other conditions. What can I do to manage them all?
Do I need to go to a clinic for sleep disorders? Is it covered by my insurance?
Do you have any brochures or other printed materials that I could use?
Which websites would you recommend?

Do not hesitate to ask questions during your appointment.

What to expect from your doctor

You may be asked several questions by your doctor, including the ones below.

Your insomnia:

What is your sleep pattern?
How long does it take to fall asleep?
Do you snore, or do you wake up choking for air?
How often are you up at night? And how long does it take to go back to sleep?
What’s your reaction when you don’t feel like sleeping?
Have you ever tried to improve your sleeping habits?

About your day:

Are you feeling refreshed or tired when you wake up?
Do you find it difficult to stay awake when driving or sitting down?
Do you take a nap during the day or do you wake up to go to sleep?
What are your evening meals?

What is your bedtime routine?

What’s your bedtime routine?
Are you currently taking any sleeping pills or medications before going to bed?
When do you get up in the morning? What about weekends?
How many hours do you sleep each night?

Other issues that could affect your sleep:

Are you a victim of stressful events?
Are you a smoker or do you drink alcohol?
Are there any sleep-related problems in your family?
Which medications are you most likely to take?