Treatment for Chronic Insomnia

The therapy for chronic insomnia involves two main goals: improving the quality and duration of sleep, also reducing daily activity disruptions associated with insomnia. One of the therapies for chronic insomnia is sleep habit intervention, which falls under CBT-I. If therapy and sleep habit interventions are not effective, medication may be recommended by doctors.

CBT-I is recommended as a first-line therapy for insomnia because it has no significant impact on health. CBT-I includes several therapies, such as:

• Sleep education and hygiene: educating patients about sleep patterns and healthy lifestyle habits/behaviours. Sleep hygiene focuses on behaviours that can improve the quality and quantity of sleep while reducing habits that disrupt sleep. For example, doctors may advise patients to sleep and wake up at the same time every day and reduce alcohol/caffeine consumption a few hours before bedtime.
• Stimulus control: many insomnia sufferers experience anxiety when trying to sleep, which can worsen their complaints. Stimulus control consists of several steps that can be taken to reduce anxiety and build a good relationship with the sleep environment. Stimulus control, such as only lying down when feeling tired, using the mattress only for sleeping, and setting the alarm at the same time every morning.
• Sleep restriction: this method aims to improve the quality and quantity of sleep by reducing time spent in bed.
• Relaxation: breathing exercises, muscle relaxation, and meditation. Biofeedback, which helps control bodily functions based on blood pressure and heart rate, can be effective in reducing insomnia complaints and improving sleep.

Medication for insomnia

Before taking medication for insomnia, it is important to consult a doctor. For many people, medications are the added therapies after behavioral therapy/CBT-I is ineffective in improving sleep quality. Medication therapy for insomnia consists of several categories:

• Benzodiazepines: psychotropic drugs, not recommended for long-term insomnia because they have a high potential for abuse and dependence.
• Z-drugs or non-benzodiazepines: have similar effects to benzodiazepines but with lower side effects and potential for abuse.
• Melatonin agonists: hormones that produce drowsiness and relaxation, no evidence in long term use.
• Dual orexin receptor antagonists: for insomnia therapy with difficulty falling asleep and staying asleep, safe for elderly and long-term use (non-psychotropic agents).