Definition of Insomnia, chronic
Insomnia, chronic: Insomnia that occurs most
nights and lasts a month or more.
The treatment of chronic insomnia consists of:
- First, the diagnosis and treatment of underlying medical or
psychological problems.
- The identification of behaviors that may worsen insomnia and
stopping (or reducing) them.
- A possible trial of sleeping pills, although the long-term
use of sleeping pills for chronic insomnia is
controversial. A patient taking any sleeping pill
should be under the supervision of a physician to
closely evaluate effectiveness and minimize side
effects. In general, these drugs are prescribed at the
lowest dose and for the shortest duration needed to
relieve the sleep-related symptoms. For some of these
medicines, the dose must be gradually lowered as the
medicine is discontinued because, if stopped abruptly,
it can cause insomnia to occur again for a night or two.
- A trial of behavioral techniques to improve sleep, such as
relaxation therapy, sleep restriction therapy, and reconditioning.
There are specific and effective
techniques that can reduce or eliminate anxiety and body
tension. As a result, the person's mind is able to stop
"racing," the muscles can relax, and restful sleep can
occur. It usually takes much practice to learn these
techniques and to achieve effective relaxation.
Some people suffering from insomnia
spend too much time in bed unsuccessfully trying to sleep.
They may benefit from a sleep restriction program that at
first allows only a few hours of sleep during the night.
Gradually the time is increased until a more normal night's
sleep is achieved.
Another treatment that may help some people with insomnia is to recondition them to associate the bed
and bedtime with sleep. For most people, this means not
using their beds for any activities other than sleep and
sex. As part of the reconditioning process, the person is
usually advised to go to bed only when sleepy. If unable to
fall asleep, the person is told to get up, stay up until
sleepy, and then return to bed. Throughout this process,
the person should avoid naps and wake up and go to bed at
the same time each day. Eventually the person's body will
be conditioned to associate the bed and bedtime with sleep.
Last Editorial Review: 3/1/2003
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