Author: Ron Cridland, MD
There are a number of options for treating insomnia. It is very common to treat insomnia with over-the-counter remedies from the pharmacy or the health food store. Prescription sleeping pills and other medications that have a sedating side effect are often used as well. The problem is that these aids do not deal with the cause of insomnia. Consequently the insomnia never resolves. Initially it may be controlled with pills but eventually the body develops a resistance to medication and they loose their effect. Then the patient is left with the difficult choice of putting up with the insomnia again or taking higher and higher dosages with more limited benefits and often greater side effects.
In someone who is at their wits end from lack of sleep, a sleeping pill may give them very significant relief from their suffering. It may help them get the sleep they desperately need so they are not falling asleep at work or while driving. It may help them cope so they can more adequately address the causes of their insomnia. If the underlying cause of the insomnia is determined and controlled, then the patient should be able to get off the sleeping pill and it’s use is only short term.
Problems arise if the underlying cause of the insomnia remains. The underlying cause along with the insomnia it causes are likely to gradually become worse. If the underlying cause is an uncontrolled medical condition like obstructive sleep apnea, then the patient may be at greater and greater risk for other medical conditions such as heart disease and stroke.
Thus, the best way to manage insomnia is to diagnose and treat the underlying cause whether it be a medical or psychiatric condition, a major stress or an underling sleep disorder. The first place to start may be with your family physician to rule out medical or psychological conditions or to get help to address psychosocial issues such as work, marital problems or other major stresses.
If the insomnia remains, then seeing a sleep disorders physician would be important in ruling out underlying sleep disorders with a Nocturnal Polysomnogram or other sleep testing. The sleep disorders physician should be able to come up with a more specific diagnosis and treatment for your insomnia.
If a sleep disorders physician is not readily available, then completing the Online Sleep Disorder Questionnaire (OSDQ) can help you and your physician identify the potential sleep disorders you may be dealing with. The results of the questionnaire will point you to other information on this web site that will help you and your physician diagnose and treat your sleep disorder.
If it turns out that you are suffering from Psychophysiological Insomnia, Inadequate Sleep Hygiene, Shift Work Sleep Disorder, Insufficient Sleep Syndrome, Delayed Sleep Phase Syndrome or one of the Parasomnias, then you will benefit from one or more of the “non-pharmacologic” or non-medication options listed here. The most effective option for treating Psychophysiological Insomnia is usually Cognitive-Behavioural Therapy for insomnia (CBTi) with a sleep disorders physician or psychologist. After years of doing CBTi with my patients I have developed an online version of this that we call the Online Insomnia Management Program (OIMP)”. Other options that may be included as part of your program are Sleep Hygiene, Relaxation Techniques, Biofeedback, Stress Management and Psychotherapy.