Insomnia Disorder 

Treatments

Cognitive behavioral therapy and medication     

Treatment Summary: Different treatments can help people with different kinds of sleep problems. For example, relaxation treatments can reduce the physical tension that prevents some people from falling asleep at night, while medications may be helpful for problems like narcolepsy. Medication is considered a primary treatment, but other ways for helping people regulate their sleep problems include cognitive behavioral therapy. Cognitive behavioral treatment is often preferred for patients suffering insomnia who have had partial success with pharmacologic treatments, and for patients who may not be good candidates for pharmacologic treatments. However, CBT in considered superior to single component treatments, like relaxation training, educational programs, or pharmacotherapy. 

• Reference: Ong, J., Cvengros, J., & Wyatt, J. (2008). Cognitive behavioral treatment for insomnia. Psychiatric Annals, 38(9), 590-596. doi:10.3928/00485713-20080901-06. Neubauer, D. (2009). New directions in the pharmacologic treatment of sleep disorders. Primary Psychiatry, 16(2), 52-58. Retrieved October 20, 2010 from PsycINFO database. 

• Submitter: N/A 

Cognitive Behavioral Therapy (CBT) 

Treatment Summary: Research and clinical studies have shown Cognitive Behavioral Therapy (CBT) to be very successful and an effective method when treating sleep disturbances, specifically insomnia. In CBT, the therapist and client work together to identify irregular sleeping patterns, as well as correct thoughts and beliefs that contribute to sleep disturbances. Cognitive Behavioral Therapy educates the client with proper information about sleep norms, age-related sleep changes, the influence of naps and exercise and reasonable sleep goals are set in order to avoid sleep-incompatible behaviors in bed. 

• Reference: Phillips, T.G., Holdsworth, J., & Cook, S. (2001). How Useful is cognitive behavioral therapy (cbt) for the treatment of chronic insomnia?. The Journal of Family Practice, 50(7), 569. 

• Submitter: Melodi Howard 

Melatonin 

Treatment Summary: During the 4 week clinical trial, the participants were administered 5mg of melatonin mixed with carboxymethylcellulose in a fast release tablet at 7:00pm. If the participant was under the age of 6, they received a dosage of 2.5 mg of melatonin at 6:00pm. Parents and caregivers were given a diary and were present daily to observe the sleep latency time, sleep onset time, wake up time, number of night wakings, duration of night wakings, and totals sleep time. Results: Mean sleep latency decreased by 29 minutes. Mean sleep onset increased by 34 minutes. Mean number of night wakings per night decreased 0.42, and the duration decreased by 17 minutes. Overall, mean total sleep time increased by 48 minutes. 

• Reference: Braam, W., Didden, R., Smits, M., and Curfs, L. (2008). Melatonin treatment in individuals with intellectual disability and chronic insomnia: a randomized placebo-controlled study. Journal of Intellectual Disability Research, 53, 256-264. 

• Submitter: Uquay Robinson 

Melatonin-receptor agonists (Ramelteon) 

Summary of Treatment: In the research referenced below, a variety of treatments were studied to explore their efficacy in the treatment of sleep disorders, specifically insomnia. One of the most common pharmacological treatments for insomnia includes melatonin-receptor agonists. 

Melatonin-receptor agonists, namely ramelteon, are a recent alternative to treating insomnia. Ramelteon works by targeting specific melatonin receptors in the hypothalamus. These melatonin receptors, MT1 and MT2, are essential to the sleep-wake cycle of the body. The suggested dosage is 8 mg right before bedtime. In addition to decreasing the delay to sleep onset, research has shown that ramelteon also increases sleep time as well. Ramelteon is not classified as a controlled substance. 

The most common side effects of ramelteon are fatigue, dizziness, and somnolence. Because of delays in absorption, ramelteon is not to be taken with or instantly after a high-fat meal. Ramelteon should not be prescribed to those experiencing severe hepatic impairment. 

• Reference: Passarella, S., & Duong, M. (2008). Diagnosis and treatment of insomnia. American Journal of Health System Pharmacy, 65(10), 927-934. doi:10.2146/ajhp060640 

Submitted by: Thomas Twomey