How Do You Fix Insomnia?

There are a variety of treatment options and lifestyle changes that can help insomnia. Insomnia treatments include keeping a consistent sleep routine, making your bedroom a calm sanctuary, keeping the room cool, using blackout curtains or sleep masks, wearing earplugs, or using white noise.

Insomnia is the most common type of sleep disorder and it involves problems falling asleep or staying asleep despite adequate opportunity to do so.

How to Fall Asleep If You Have Insomnia

Treatment to fix insomnia includes good sleep hygiene. This includes the following:

• A consistent sleep routine
  • Go to bed and wake up at the same time each day, even on weekends
• Make your bedroom a calm sanctuary
  • Dim lighting
  • Scented oil diffusers
  • Soft music
• Keep the room cool
  • 65 F/18.3 C is considered ideal
• Use blackout curtains or sleep masks to reduce light
• Wear ear plugs or use white noise to block outside noises
• Don't stress if you can't fall asleep right away
• Sleep in comfortable loose-fitting pajamas or sleep naked to help regulate body temperature
• Stimulus control
  • Don't go to bed until you feel sleepy
  • Only use the bed for sleep and sex
  • Don't watch TV or read in bed
  • If you are awake more than 20 minutes after getting into bed, get out of bed and sit in a chair and do something boring such as puzzles or knitting (something that does not involve a screen) until you are sleepy
  • Avoid daytime napping

Lifestyle changes that can help fix insomnia include:

• Avoid things that will keep you awake, such as caffeine and alcohol
• Avoid exercise before bed
• Remove the alarm clock
• Use a weighted blanket
• Wear socks to warm your feet
• Write down stressful thoughts before going to bed so you don't think about them
• Calm yourself before bedtime
  • Breathing exercises
  • Guided imagery
  • Meditation
  • Take a hot bath or shower
  • Practice relaxing yoga
  • Listen to relaxing music
  • Listen to Autonomous Sensory Meridian Response (ASMR)
• Try night time snacks that increase serotonin to help you sleep, such as:
  • Nut butter on toast
  • Oatmeal
  • Warm milk
  • Whole grain cereal with milk (avoid sugary cereals)
  • Fruit smoothie
  • Cottage cheese

Other treatments for insomnia include the following:

• Cognitive behavioral therapy for insomnia (CBT-I)
  • A short, structured approach that takes from six to eight sessions
  • Focuses on the connection between the way a person thinks, the things they do, and how they sleep
  • Providers help people identify thoughts, feelings, and behaviors that contribute to insomnia and clarify or reframe these thoughts, feelings, and behaviors in a way that encourages restful sleep
• Sleep education
  • Learning what happens during sleep and how insomnia can develop and persist
• Sleep restriction or sleep compression
  • Sleep restriction involves keeping a "sleep diary" to track how much time is spent in bed and how much of that time is spent sleeping versus awake so a person can understand their habits
    • A specific schedule is set for when to go to bed and when to get up, even if the person doesn't sleep the entire time
    • This helps make a person more tired so that they will sleep better the next night
    • People can feel more tired during the day in the beginning of the process, which can cause problems with activities in which a person must be alert, such as driving
  • Sleep compression is similar, and also involves keeping a sleep diary and setting a routine bedtime and wake time
    • It also involves shortening the window of time in bed more gradually
• Sleep medications, both over-the-counter (OTC) and prescription
  • Over-the-counter sleep aids: generally, not recommended to treat chronic insomnia
    • Antihistamines such as doxylamine or diphenhydramine (Benadryl, Nytol, ZzzQuil)
    • Melatonin, a hormone normally produced by a gland in the brain
      • Marketed as a dietary supplement in the United States
      • Ingredients, dose, and purity of dietary supplements are not regulated
  • Prescription sleep medications
    • Benzodiazepines: quazepam (Doral), triazolam (Halcion), estazolam (ProSom), temazepam (Restoril), and flurazepam (Dalmane)
    • Nonbenzodiazepines: zaleplon (Sonata), eszopiclone (Lunesta), zolpidem (Ambien), zolpidem extended release (Ambien CR), zolpidem dissolving tablet (Edluar), zolpidem oral liquid spray (Zolpimist), and zolpidem dissolving tablet at a lower dose for middle of the night use (Intermezzo)
    • Dual orexin receptor antagonists (DORAs): lemborexant (DayVigo) and suvorexant (Belsomra)
    • Histamine receptor antagonist: low-dose doxepin (Silenor)
    • Melatonin receptor agonist: ramelteon (Rozerem)

Symptoms of insomnia include the following:

• Difficulty falling asleep or staying asleep
• Variable sleep
• Daytime fatigue or sleepiness
• Difficulty concentrating
• Decreased motivation or energy
• Forgetfulness
• Irritability
• Depression
• Anxiety
• Increased errors or accidents
• Persistent worry about sleep

Insomnia is usually caused by multiple factors. The main cause of insomnia is believed to be a state of mental and/or physical hyperarousal that interferes with falling asleep or staying asleep.

Causes of insomnia include the following:

• Changes in sleeping environment
  • Light
  • Noise
  • Temperature
• Poor sleep habits
  • Irregular sleep schedule
  • Napping late in the afternoon
  • Sleeping in later to make up for lost sleep
  • Using the bed for activities other than sleep
• Stress
  • Loss of a loved one
  • Loss of a pet
  • Divorce
  • Job loss
• Illnesses, especially those that cause stress or difficulty breathing
• Surgery
• Pain
• Unhealthy lifestyle habits
  • Working late
  • Playing video games and using other electronic devices including cell phones, computers, and tablets
  • Diet choices
    • Stimulants, such as caffeine
    • Alcohol
    • Heavy meals
    • Spicy foods
• Use of or withdrawal from certain medications and illegal drugs
  • Blood pressure drugs
  • Anti-asthma medications
  • Antidepressants
• Irregular sleep schedules that disrupt the circadian rhythm
  • Jet lag
  • Shift work
• Mental health problems
  • Depression
  • Anxiety
  • Posttraumatic stress disorder (PTSD)
• Neurological disorders
  • Alzheimer's disease
  • Attention-deficit/hyperactivity disorder (ADHD)
  • Autism spectrum disorder
  • Parkinson's disease
• Other sleep disorders
  • Obstructive sleep apnea
  • Restless leg syndrome
  • Parasomnias
    • Sleepwalking
    • Nightmares
    • Sleep paralysis
• Pregnancy
  • Nighttime urinary frequency
  • Reflux
  • Discomfort
  • Disrupted breathing
  • Restless leg syndrome
• Genetics
• Age: teenagers and elderly experience insomnia more frequently
• May not have a known cause

Sleep disorders are diagnosed with a patient history and physical exam. Tests or procedures that may be used to diagnose sleep disorders or to rule out other underlying conditions include the following:

• Daily sleep log
• Sleep study (polysomnography)
• Record of activity and movement with a monitor or motion detector, generally worn on the wrist throughout the day and night (actigraphy)
• Home devices that monitor breathing, oxygen saturation, position, and heart rate
• Home sleep apnea testing
• Core body temperature measurements
• Melatonin sampling
• Hormone tests
• Electrocardiogram (ECG)
• Pulmonary function tests
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI) of the brain