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What Are the Treatments?

Transient insomnia, which may occur during travel, usually disappears when you return to a regular sleep pattern. Short-term insomnia, which may be caused by a disruption or family illness or by job stress, may be treated with natural sleep aids or, in some cases, with medication. Chronic insomnia, which disrupts sleep for extended periods of time, may call for a thorough physical examination, alteration of some life habits, and perhaps psychotherapy to identify a hidden cause.

For circadian rhythm disorders, most people will readjust after a few days on a new schedule. If you have to sleep during the day, keep the bedroom as quiet and dark as possible. If insomnia is due to a physical ailment or condition such as diabetes or menopause, treating that underlying condition should correct the insomnia.

Persistent or severe insomnia is something you should discuss with your doctor in order to rule out an underlying ailment and possibly to try an appropriate medication. If you suspect that your sleeplessness is caused by depression, ongoing anxiety, or stress, your doctor may want you to see a psychiatrist or psychologist. You may be referred to a sleep evaluation center, where experts will conduct physical and psychological tests and monitor your sleep pattern in order to evaluate your situation in depth.

Each year about 5 million people use sleep medications, but doctors no longer prescribe them as freely as they once did. Barbiturates, in particular, are to be avoided whenever possible because of their addictive power, the danger of overdose, and their toxicity when combined with alcohol. If you take barbiturates, do so only for a day or two at a time and only as prescribed for your particular condition.

Benzodiazepines such as triazolam and temazepam are safer than barbiturates, but even they can cause dependence, and they can be fatal if taken with alcohol or other drugs that depress the central nervous system. Benzodiazepines gradually lose their effectiveness and may even worsen insomnia as people develop tolerance to them.

It is difficult to stop using benzodiazepines, because abrupt withdrawal may cause distressing symptoms, including renewed insomnia. Anti-insomnia drugs, such as Ambien, Lunesta, and Sonata, are not thought to be physically addicting.

Many poor sleepers simply need help relaxing. If you're a habitual insomniac and trying to get to sleep just makes you more awake, the following alternative choices may help reduce your worry about sleep while relaxing your body and mind. If the root cause of insomnia is stress, any treatment must address the underlying problem.

Lifestyle

Moderate exercise — a 20- to 30-minute routine three or four times a week — will help you sleep better and give you more energy while awake. Tailor the routine to your physical condition, and exercise in the morning or afternoon, not close to bedtime. Breathing exercises can promote relaxation; here's a routine you can do anywhere, anytime:

1. Exhale completely through your mouth. Inhale through your nose to a count of four.
2. Hold your breath for a count of seven.
3. Exhale through your mouth for a count of eight. Repeat the cycle three times.

Mind/Body Medicine

Meditation, yoga, and biofeedback can reduce tension and promote better sleep. Visualization or guided imagery is an effective path to relaxation: Hold a peaceful image in your mind before bedtime. You can learn these techniques from an instructor, a how-to book, or an instructional tape.

Nutrition and Diet

High or low blood sugar can disrupt sleep patterns. To help stabilize blood sugar, avoid sweets and fruit juices close to bedtime. To activate the brain's sedative chemicals, eat starchy food — a plain baked potato, a slice of bread, or an apple — half an hour before bedtime.

Warm milk, a traditional sleep aid, may provide more psychological than physical benefit. It does contain tryptophan, a sleep-inducing amino acid, but it also contains many other amino acids that compete to enter the brain.

At-Home Remedies

Be sure your bedroom is quiet and dark. Earplugs and eye shades may help; light comes in even through closed eyelids.

Both children and adults may have trouble sleeping if they are over stimulated by activity or watching television just before bedtime. A quarter hour of quiet conversation, light reading, or soft music may make all the difference.

If you wake up at night and can't go back to sleep, remain quiet and relaxed. Sleep is normally punctuated by periods of restlessness, or even waking. Be patient; sleep usually returns.

Remember, a few nights of poor sleep do no long-term harm. Even if you toss and turn trying to get to sleep, you are probably getting more periods of sleep than you think.