By Erika Manis, MD
Daniel J. and Maria H. Sak Sleep Wellness Center
Do you frequently have trouble falling or staying asleep? Taking longer than 30 minutes to fall asleep or being awake for more than 30 minutes after falling asleep may be abnormal when persistent and associated with daytime impairment such as fatigue.
A discussion with a healthcare professional can help first assess for frequent comorbid sleep or psychiatric disorders such as obstructive sleep apnea, depression, anxiety, or substance use that could be causative or contributory. Other known risk factors for insomnia are female gender and family history.
Evaluation may include a sleep study depending on information revealed from a detailed history, including a review of medication and a physical exam. You will likely be asked to keep a sleep diary and/or wear an actigraph (if available), which is similar to a wearable fitness tracker. This is used, in part, to look for sleep patterns that may represent a circadian rhythm disorder that would be approached differently.
Both behavioral and pharmacologic (medication) treatment options are available for insomnia. Cognitive Behavioral Therapy for Insomnia (CBT-I) is preferred to hypnotics due to safety and efficacy. There are fewer side effects and longer-lasting results once discontinued. It is typically six to eight one-hour weekly sessions, although a brief intervention may be accomplished in as few as three to four sessions. This is done with a sleep psychologist who focuses not only on sleep hygiene (sleep habits) but, perhaps more importantly, on sleep restriction (intentional mild sleep deprivation to increase sleep drive) and stimulus control (getting out of bed when unable to sleep to build a positive relationship with the bed and bedroom) as well as some shared techniques of relaxation (progressive muscle relaxation, guided imagery, and diaphragmatic breathing) and cognitive restructuring (addressing unhelpful thoughts).
Group formats, telemedicine, and computerized programs have increased access to care for this preferred treatment modality. A sleep aid, however, may ultimately be indicated after a thorough risk-benefit discussion with a prescribing provider. New medication classes are available that may be safer due to reduced risk for daytime sedation and dependence.
