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Ask the Doctor: Are there any reliable treatments for insomnia?

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Q: Are there any reliable treatments for insomnia? 
 
A: Most experts agree that sleep disruption is the one symptoms that should be addressed first.  Sleep allows the tired achy muscles to recover; and lack of sleep increases pain and fatigue.  

There are many ways to approach insomnia, starting with good sleep habits, especially winding down, choosing a schedule and fixed wake time, aiming for 8-10 hours sleep per night, and avoiding TV and tablets at night.  Then an over-the-counter remedy may be helpful such as diphenhydramine (Benadryl, Tylenol PM or Advil PM), doxylamine (ZzzQuil), melatonin, or an herbal sleep aid.  

Next, consider non-hypnotic medications such as eszopiclone (Lunesta), zaleplon (Sonata), or ramelteon (Rozerem).  If these are insufficient, then a hypnotic agent such as zolpidem (Ambien) might work, but is associated with many more side effects.  Doctors will sometimes prescribe benzodiazepines such as clonazepam, temazepam, lorazepam, etc., but these can be habituating and at higher doses may actually interfere with sleep.

 If these don’t work, then I recommend consulting a sleep specialist.  So the answer to your question is that there are good treatments for sleep, but none that reliably work for everybody.

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