Insomnia is the most common sleep complaint among Americans. It can be either acute, lasting one to several nights, or chronic, even lasting months to years. When insomnia persists for longer than a month, it is considered chronic. About 30-40% of adults say they have some symptoms of insomnia within a given year, and about 10-15 percent of adults say they have insomnia regularly. Most people experience chronic-intermittent insomnia, which means difficulty sleeping for a few nights, followed by a few nights of adequate sleep before the problem returns.

Symptoms of insomnia include:

  • Difficulty falling asleep
  • Waking up frequently during the night
  • Difficulty returning to sleep after awakening
  • Waking up too early in the morning
  • Feeling unrefreshed in the morning
  • Unrefreshing sleep
  • Daytime fatigue
  • Difficulty concentrating
  • Mood disturbances


Evaluation will be performed to assess each individual’s medical and psychological history. Where appropriate, a physical examination and sleep study may be indicated.

When appropriate, a main treatment for primary insomnia should be cognitive-behavioral therapy (CBT). CBTI addresses the factors perpetuate or maintain sleep difficulty. Certain sleep-related behaviors or ways of thinking about the problem of insomnia can perpetuate the problem. Unlike sleep medication which only serves to treat the symptoms of insomnia, CBTI is targeted to identify and correct the underlying causes of the problem.

Relaxation techniques, such as yoga, meditation, breathing techniques, and guided imagery may be especially helpful in preparing the body to sleep. Exercise, done early in the day, can also be helpful in reducing stress and promoting deeper sleep.

Behaviorally-based therapies may not be sufficient to manage all cases of insomnia. In some instances sleep medication may serve as a more effective approach either alone or in combination with CBT. Sleep medications, either herbal or over the counter, or prescription, may be appropriate if the causes of the insomnia have been thoroughly evaluated and it has been determined that behavioral techniques are either not appropriate or have been tried and deemed to be inadequate.

Sleep Aids and Insomnia

One of the most common approaches to the treatment of insomnia in the general population is sleep medication. Sleep aids may be obtained via prescription or over the counter (OTC). Prescription medications that promote sleep are called hypnotics and they are the most effective sleep aids available. However, they are prone to side effects such as morning grogginess, memory problems, and sleepwalking. Due to their sedating properties some antidepressants (i.e., trazodone) and anti-anxiety medications may be prescribed at low dosages specifically for primary insomnia.

Chronic use of sleep medication can lead to the development of physical and or psychological dependence, tolerance (needing to increase the dosage over time to get the same benefit) and may temporarily worsen sleep upon discontinuation.

The use of sleep aids may be optimized by the following:

  • begin with the lowest possible effective dose
  • be short-term, if used nightly
  • be intermittent, if used long-term
  • be used only in combination with good sleep practices and/or behavioral approaches

The particular medication prescribed to treat insomnia should depend on a patient's diagnosis, medical condition, use of alcohol or other drugs, age, and need to function when awakened during the usual sleep period.

Persons taking hypnotics should be advised that sleep aids should be gradually decreased rather than stopped all at once. Without gradual tapering, stopping hypnotic use may cause insomnia to come back. Individuals should confer with their prescribing physicians before discontinuing sleep medications.

Discontinuing sleep aids is not a requirement for those interested in participating in the CBTI Program at IISHC. For those individuals who are interested in tapering or discontinuing sleep medications, such goals can be integrated into a personalized treatment plan. It will be important to discuss your goals concerning sleep medication use with the insomnia specialist prior to commencing treatment.

Supplements for Sleep

A number of supplements are available over the counter that can help with insomnia. The most common of these include melatonin, valerian, and magnesium. The effectiveness of supplements varies from person to person. It is important to be aware that these products are not regulated by the federal Drug Administration (FDA) and therefore may vary in potency and the presence of other unknown ingredients. Our team can help guide you to trustworthy sources for these products, and instruct on optimal dosing schedules and conditions.

Sleep Topics

Sleep Basics

Children's Sleep

Restless Leg Syndrome


Sleep in Elderly

Womens' Sleep




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