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How Insomnia Works

Behavioral Therapy, Hypnotics and Over-the-counter Treatments
Prescription medicines may be used to treat insomnia if sleep habit changes don't help.
Prescription medicines may be used to treat insomnia if sleep habit changes don't help.
© Annie-Claude Bédard/iStock/Thinkstock

Nineteenth-century novelist Emily Brontë is said to have walked herself to sleep, she was so desperate for rest; whether that's fact or fiction, what we do know is that insomniacs will try all sorts of things (nope, counting sheep isn't thought to work) to nod off.

It's important to wind down before bedtime -- which probably won't include walking in circles like Brontë. In fact, exercise, especially moderate-to-vigorous exercise, isn't recommended during the three to four hours before your bedtime because of its energizing effect. Instead, try yoga as part of a healthy bedtime routine, and stick to the morning spinning class.

In addition to making some changes to the bedtime routine, The American Academy of Sleep Medicine recommends insomniacs try cognitive behavioral therapy, used to help control worries and anxiety about sleep and considered to be one of the most successful treatments. Relaxation techniques such as mindful meditation and controlled breathing, too, offer strategies to relieve sleep anxiety as bedtime approaches. Other behavior therapies include retraining yourself in how you think about your bed. For example, restricting the amount of time you spend in your bed (and gradually increasing the duration) may help reduce anxiety about going to sleep; others may benefit from a temporary treatment where the individual lies in bed without trying to fall asleep.

When behavior and lifestyle changes don't help, though, medications may.

Over-the-counter remedies, such as melatonin, tryptophan and valerian supplements, may work for some insomniacs. Melatonin, for instance, has shown to be effective treatment for sleep disorders caused by circadian rhythm problems (such as jet lag), and is considered to be key in managing how well the body handles its day-night cycle. Alternative remedies aren't regulated by the U.S. Food and Drug Administration (FDA), though, and some may contain ingredients such as antihistamines; follow a health professional's advice when trying at-home sleep aids.

Some insomniacs, acute and chronic, may need prescription medication to find relief. Prescription medicines used to treat insomnia are sedative-hypnotics, such as zolpidem (prescribed as Ambien) and eszopiclone (prescribed as Lunesta), and while they may work, they may also be habit forming and are usually only taken for short periods of time. Primary insomnia may also be treated with prescription medications such as benzodiazepine receptor agonists (BzRAs), as well as with ramelteon, a melatonin receptor agonist that works like melatonin in the brain. Low-dose antidepressants may be prescribed to help insomniacs with depression or anxiety.