Insomnia

About Insomnia

Insomnia disorder affects approximately 10 percent of adults chronically and 30 to 35 percent occasionally. Diagnostic criteria require difficulty falling asleep latency over 30 minutes, staying asleep, or early morning awakening at least 3 nights per week for 3 months, causing daytime impairment. Risk factors include female sex, age, medical conditions, psychiatric disorders depression, anxiety, medications, caffeine, alcohol, shift work, and irregular schedules. Chronic insomnia involves hyperarousal and conditioned arousal where the bed becomes associated with wakefulness and anxiety. Sleep hygiene measures include a regular schedule, a cool dark quiet bedroom, less screen use before bed, limiting caffeine and alcohol, and regular exercise. The most effective non pharmacological treatment is Cognitive Behavioral Therapy for Insomnia CBT I, which includes stimulus control bed only for sleep and sex, sleep restriction consolidating sleep, cognitive restructuring, and relaxation techniques. CBT I is more effective long term than medications. Medications include benzodiazepine receptor agonists zolpidem Ambien, eszopiclone Lunesta that are generally recommended only for short term use, melatonin receptor agonists ramelteon, and orexin receptor antagonists suvorexant Belsomra, lemborexant Dayvigo. Over the counter melatonin is widely used but quality varies.