ADULTS
Exhaust every possible option before resorting to drugs to cure insomnia.

Practice good sleep hygiene: avoid using alcohol in the evening. Avoid caffeine for at least 8 hours before bedtime. Give up smoking (nicotine is a stimulant).

Establish a regular bedtime, but don't go to bed if you feel wide awake. Use the bedroom for bedroom activities only. Once in bed, use creative imagery and relaxation techniques to keep your mind off unrestful thoughts. Avoid staying in bed for long periods of time while awake, or going to bed because of boredom.

Take your TV or computer out of your bedroom. If not, your brain becomes used to the stimulation and starts to expect it when you are there. This makes it harder for you to fall asleep.

Relax by reading, taking a bath, or listening to soothing music before getting to bed.

A snack before bedtime helps many people. Foods such as warm milk or turkey have a natural sleep inducer called L-tryptophan.

Exercise regularly, but not in the last two hours before going to bed. Exercise, especially aerobic exercise, has been show to make people fall asleep faster and benefit from deeper and more restful sleep. Sex can be a natural sleep inducer and helps some people.

Avoid emotional upset or stressful situations prior to bedtime.

INFANTS
Avoid being readily available to a child during the night; otherwise, the child may become dependent on attention and become sleepless if deprived of it.

CHILDREN
For children who have trouble falling asleep, try to make sure that the child is not disturbed by unnecessary noise. Leaving a radio playing soft music may help cover up disturbing noises.

Avoid sending a child to bed as punishment which can result in poor sleep caused by fear.

Never give a child sleeping medicine without consulting the doctor first. Generally, it is unwise to treat the problem with drugs.

MEDICATION
Medication should be a last resort.

Antihistamines such as Sominex, Nytol, and Compoz (all approved by the FDA) are available without a prescription. These medications are not without side-effects: some people complain of a "hangover" effect the next morning.

If these fail, you may want to ask you health care provider to recommend other options.

Avoid all sedatives, including the benzodiazepines, during the first 3 months of pregnancy.

• a sleeping problem becomes persistent and unbearable despite home treatment.
• if sleeping problem occurs more than 3 nights per week for more than 1 month
• if the insomnia is accompanied by other worrisome symptoms such as chest pain or shortness of breath.

• type
  • Do you have difficulty falling asleep or staying asleep (insomnia)?
  • Do you awaken from sleep not feeling rested?
  • Do you awaken many times at night?
• time pattern
  • Is the problem persistent?
  • For how long?
  • Did the problem seem to be resolving after changing your work shift pattern?
• aggravating factors
  • Did it begin after stopping the use of alcohol at bedtime?
  • Did it begin after stopping the use of a sleeping aid
  • What medications do you take?
  • Do you take any herbal supplements or alternative medicine remedies?
  • Do you drink much coffee? Have you recently cut down on your coffee intake?
  • Is there any excessive stress or anxiety?
• sleep schedule
  • How much do you normally sleep? What hours?
  • What do you do during the few hours before you go to bed?
  • Do your sleep schedule change frequently? (shift work)
  • Do you fall asleep at inappropriate times or places?
  • Does your sleep schedule change drastically on weekends?
• associated complaints
  • Does it occur in response to reminders of a traumatic event?
  • Does it occur around the time you ingest some form of a stimulant substance?
  • Does it occur around the time you use a hypnotic medication?
  • Are you associating the bedroom with insomnia?
  • Do you worry excessively about sleep?
  • Are there also breath holding spells or times of snoring?
  • Do you have physical aches or pains that prevent you from sleeping?
  • What other symptoms are also present?

• sleep log record
• psychological tests
• thyroid tests (TSH, T3, T4)

In some rare cases, your health care provider may want you to see a sleep medicine specialist who will perform a sleep study (polysomnography)

MEDICATIONS
In most cases, this will not be necessary. Your health care provider can explore with you the possibility of using prescribed medications if everything else has failed.

Some antidepressants such as Elavil (amitriptyline) can be used at bedtime because they are sedating. They require a prescription. If insomnia is caused by depression, proper treatment of the depression with other appropriate medications or therapy should solve the problem. Benzodiazepines such as Valium (diazepam) or Ativan (lorazepam) are anti-anxiety medications that can also help induce sleep. They must be used with caution because they can be addictive. They too require a prescription.

Newer medications called hypnotics are now available. They are help reduce the time needed to fall asleep but are far less likely to be addictive than benzodiazepines. Ambien (zolpidem) and Sonata (zaleplon) are two examples.

After seeing your health care provider:
If a diagnosis was made by your health care provider related to sleeping difficulty, you may want to note that diagnosis in your personal medical record.