Insomnia
Finding The Right Treatment
Treatment
There are multiple proven means of treating insomnia including psychotherapy, behavioral changes, and sometimes medications.
Finding a therapist
Talk therapy can support individuals with insomnia through teaching new ways to work with symptoms, identifying behavior changes, and addressing the potential anxiety and stress that often come with insomnia. Most therapists have experience working with adults who have been diagnosed with insomnia and commonly associated mental health conditions such as depression and anxiety.
There are different kinds of professionals who can provide effective therapy, including:
- Clinical psychologists (PhD or LLP)
- Licensed clinical social workers (LMSW or LCSW)
- Licensed professional counselors (LPC)
- Licensed clinical professional counselors (LCPC)
- Licensed Marriage and Family Therapists (LMFT)
- National certified counselors (NCC)
CBT-i
Therapists who treat insomnia use an effective form of therapy called cognitive behavioral therapy specifically for insomnia (CBT-i). The therapist and patient meet for as little as 6 to 8 sessions, and together look at how one's behavior and thoughts may be affecting their sleep. The therapist will help the patient identify behavioral changes to improve sleep quality and learn tools to relax and prepare the body for sleep.
The CBT-i therapist often provides essential education about sleep, and analyzes their patient's sleep patterns to find tools tailored to a person's individual needs. CBT-i has shown to be highly effective in treating insomnia as patients often report improvements in falling asleep, staying asleep, and overall sleep quality.
The decision to start therapy
Many people try to cope with their distress on their own, and then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.
For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.
Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.
Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.
Where to start
Requesting one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.
To find a therapist who takes one's insurance, the National Institute of Mental Health offers a comprehensive list of resources.
Psychology Today also lists therapists by type, location and insurance.
Determining whether medications will play a role in treatment
While therapy and behavioral changes can drastically improve the symptoms of insomnia, sometimes medications are called for. These often include “Z” drugs such as zolpidem (Ambien), escitalopram (Lunesta), or zaleplon (Sonata). These drugs should never be taken with alcohol, benzodiazepines, or any other sedating medications. The Drug Enforcement Administration has classified these medications as Category IV drugs, among drugs that can lead to abuse or addiction.
There are five categories of potentially addictive drugs, ranging from illegal drugs (Category I) to lawfully prescribed drugs that are Category II to Category V medications. Category V drugs have the least abuse potential.
The “Z” drugs sometimes have had an unusual effect on some individuals, including sleepwalking. As a result, in 2019, the Food and Drug Administration (FDA) issued a requirement for a boxed warning that medications in this class can cause unusual and dangerous behavior, such as sleepwalking, sleep driving, or engaging in sex while asleep. Anyone who has had such a reaction with any one of the three medications listed is prohibited from taking them in the future.
Healthcare providers that can prescribe medications
Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN.
Dietary supplements
There are an increasing number of supplements, such as an herb, vitamin, mineral, and other supplements claiming to improve sleep, depression, stress, restlessness, or anxiety. While it is possible for a supplement to improve one’s symptoms, their effects are often unproven.
Be aware that dietary supplements are not controlled by the FDA and, therefore, are not subject to the standards of quality, uniformity, and testing for efficacy and safety as regulated medications. It is important to share a list of all medications and supplements with one's treating provider because some of them may interact with the medications they prescribe.