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CBT-I is especially great for the elderly, for whom medication often isn’t as effective and sometimes results in more severe side effects. Another bonus: It has none of the adverse effects of medication. CBT-I is more effective than medication for treatment of chronic insomnia, since it addresses underlying causes instead of symptoms. Rather than jumping right to medication, I recommend what’s called cognitive behavioral therapy for insomnia (CBT-I). Treatment for Sleep ProblemsĪre you familiar with the saying, “Slow and steady wins the race?” That’s the best approach when it comes to treatment for chronic insomnia.
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There are also certain people for whom these drugs are not recommended or safe, including pregnant or breastfeeding women, older adults or people already on existing sedative/hypnotic medications. Some people even experience potentially dangerous sleep-related behaviors, including eating, walking or driving while not fully awake. While prescription sleep medication can help you sleep in the short term, it can also result in many undesirable side effects, such as physical addiction, needing to take more to have the same effect (tolerance), falls, dizziness, headache, gastrointestinal problems, prolonged drowsiness, memory or functional problems during the day and increased risk of developing dementia. Many can be habit forming, especially those classified as benzodiazepines, which depress the central nervous system. Because I’m particularly attuned to addiction, I’m hesitant to offer these medications as a first-line treatment for chronic insomnia. Some ask if I’ll prescribe them a sleep aid to help in the short term. But change can take time, and sometimes patients want some quick relief. Once my patients and I have a handle on what’s causing the insomnia, I’ll help them come up with a plan to alter their behaviors and thinking processes. As we get older, our sleep patterns change, and eventually we see a marked drop in stage-four sleep, or deep sleep, which affects your energy level and immune function, among other things. And sleep problems are a common symptom of depression, anxiety and post-traumatic stress disorder.Īge can be a factor as well. Stress, drugs and alcohol use (especially closer to bedtime), and nighttime or irregular work shifts can be culprits too. The stimulants in that late-afternoon cup of coffee or cigarette right before bed can make it harder to doze off, as can the use of electronic devices too close to bedtime. More often than you’d think, it’s at least partially due to poor sleep hygiene. Using these details, I can get a better idea of the root cause(s) of their sleep troubles. This includes details like sleep and wake times, how many times they wake up each night and what wakes them up (noise, light, etc.). To look for patterns, I ask patients to keep a sleep journal for several weeks. I start by asking how often insomnia occurs and in what ways it impairs the patient’s life. So, it’s important for me to help patients find a solution. Lack of sleep can also have a negative impact on your long-term health. Research shows that without enough sleep, you’re at increased risk for everything from depression, to car accidents, to relationship difficulties, to performance issues at work or school. Some people have episodic sleep problems, which are sometimes related to a stressful life event and only last a short time, usually resolving on their own.īut others may struggle with longer-term, or chronic, insomnia, defined as sleep problems that occur at least three times a week for at least three consecutive months. You may know insomnia as not being able to sleep, which can include lying awake all night, tossing and turning until morning. I start by taking their history, including what brought them in, and hear a lot of similarities when it comes to symptoms. They’re often at rock bottom, suffering from intense emotional and physical withdrawal symptoms stemming from substance abuse. I am an addiction psychiatrist, so it probably comes as no surprise that most of my patients come to see me for problems related to their addiction.