In other words, when persistent insomnia is a problem, before your doctor writes a prescription for a sleeping pill, ask whether there are other remedies that may be safer, more effective and longer lasting.
For example, if pain or other symptoms of a medical disorder are keeping you awake, the first step should be treatment of the underlying ailment to minimize its sleep-disrupting effects. I once spent three sleepless nights tortured by intense itchiness until a dermatologist prescribed medication for what turned out to be an invasion of bird mites. More recently, my middle-of-the-night leg cramps have been nearly entirely eliminated by consuming eight ounces of quinine-containing tonic water (actually, diet tonic) every night before bed.
If you can’t handle that amount of liquid close to bedtime, drink it earlier in the evening or perhaps try an herbal remedy that I use when traveling: Hyland’s Leg Cramps, which contains quinine as one of its active ingredients.
Sometimes, the medication given to treat a chronic ailment interferes with the ability to get a good night’s sleep. In that case, the doctor may be able to prescribe a lower dose, substitute a different drug or adjust the timing. But when the symptoms of a chronic ailment itself disrupts sleep, treatment by a specialist, including perhaps an expert in pain management, may be needed to improve your ability to sleep. If persistent emotional problems are what keep you awake, consider consulting a psychologist, psychiatric social worker or psychiatrist before reaching for a sleeping pill.
Cognitive behavioral therapy is now considered the best treatment for insomnia, especially for older adults. It teaches people to challenge disruptive negative thinking and replace it with positive thoughts that counter arousal and induce relaxation. Before going to bed, try using soothing imagery or meditation to reduce cognitive arousal.
The American College of Physicians recommends cognitive behavioral therapy as “the first-line treatment for adults with chronic insomnia.”
It is much safer than drugs and, unlike sleeping pills that work only when taken and shouldn’t be used long-term, cognitive behavioral therapy for insomnia, or CBT-I, teaches effective strategies that continue to work long after the therapy ends.