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Insomnia, Chronic

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Insomnia that occurs mostInsomnia, chronic: Insomnia that occurs mostnights and lasts a month or more.The treatment of chronic insomnia consists of:First, the diagnosis and treatment of underlying medical or psychological problems.The identification of behaviors that may worsen insomnia and stopping (or reducing) them. A possible trial of sleeping pills, although the long-term use of sleeping pills for chronic insomnia is controversial. A patient taking any sleeping pill should be under the supervision of a physician to closely evaluate effectiveness and minimize side effects. In general, these drugs are prescribed at the lowest dose and for the shortest duration needed to relieve the sleep-related symptoms. For some of these medicines, the dose must be gradually lowered as the medicine is discontinued because, if stopped abruptly, it can cause insomnia to occur again for a night or two.A trial of behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, and reconditioning. There are specific and effectivetechniques that can reduce or eliminate anxiety and bodytension. As a result, the person's mind is able to stop "racing," the muscles can relax, and restful sleep canoccur. It usually takes much practice to learn thesetechniques and to achieve effective relaxation.Some people suffering from insomniaspend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that atfirst allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night'ssleep is achieved.Another treatment that may help some people with insomnia is to recondition them to associate the bedand bedtime with sleep. For most people, this means notusing their beds for any activities other than sleep andsex. As part of the reconditioning process, the person isusually advised to go to bed only when sleepy. If unable tofall asleep, the person is told to get up, stay up untilsleepy, and then return to bed. Throughout this process,the person should avoid naps and wake up and go to bed atthe same time each day. Eventually the person's body willbe conditioned to associate the bed and bedtime with sleep.



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