Stimulus control therapy teaches people simple methods that often work:

Lifestyle/behavior programs for sleep have been studied and are at least as effective, and maybe better, than sleeping pills. While they require effort and may take up to several weeks to work, the benefits can still be seen for at least up to two years. Sleep experts often recommend a combination of more than one lifestyle/behavior program for chronic insomnia, and sleep hygiene is typically included as one of the recommendations.

Sleep hygiene teaches people to avoid stimulating activity before bed, to exercise regularly (but not within 3 hours of bedtime), to turn off the television and radio in the bedroom, to maintain a comfortable temperature in the bedroom, and to avoid large bedtime snacks. These approaches are harmless, but are not likely to improve insomnia significantly unless combined with other lifestyle/behavioral treatments.

A sleep hygiene program is recommended for all people with insomnia. It includes the following list of instructions:

• Go to bed only when tired
• Participate in relaxing activities right before bedtime
• Use the bedroom only for sleep (or sexual activity)
• Avoid naps
• Avoid caffeine, cigarette smoking, and alcohol within four to six hours of going to bed
• Keep the sleep environment free from noise, excessive light, visible clocks, extreme temperatures, and other sleep disturbers
• Decrease the amount of fluids you drink before bedtime
• Avoid heavy exercise immediately before bedtime
• Exercise during the day or late afternoon but not near to bedtime
• Wake up at the same time each day

These drugs have fewer side effects than benzodiazepines (Halcion, Restoril, Prosom, Dalmane, many others). Their effects are shorter lasting, so that the next morning grogginess or hangover feeling does not occur as often. They impact the dream phase of sleep less (which is the restorative phase of sleep) than other classes of sleep drugs.

Side effects are generally minor such as headache and mild nausea. The newer generic preparations differ from the brand name versions in that they have a different coating which may increase the likelihood of gastrointestinal side effects such as nausea or diarrhea.

Some of the drugs in this class are better at addressing problems falling asleep, while others are better for those who wake up in the middle of the night. Your doctor will recommend the one that best addresses your particulor sleep pattern.

These medicines are best used temporarily for short periods of time while trying some of the behavioral methods for improving sleep in the long-term.

This doesn't work as well as stimulus control therapy, but may work for some people and is not harmful to try. Some experts believe it helps by resetting the inner "clock" in the brain that controls sleep. Also, limiting the amount of time lying awake in bed makes some people less anxious about their sleep pattern.

Individuals are instructed to:

• Go to bed much later than usual
• Stay in bed only when they are asleep (even if this is for only four or five hours)
• Increase the amount of sleep time gradually, by going to sleep 15 minutes earlier each week
• Get up at the same time each morning

A sleep relaxation program (or sleep relaxation training) attempts to increase relaxation at bedtime. The individual is instructed to tense and then relax different muscle groups while lying down, usually starting with the legs and then moving up the body. Individauls also may be instructed to concentrate, or "meditate", on pleasant or relaxing images, and to gently "stop" unpleasant thoughts from occupying the mind.

While useful for some people, relaxation techniques are generally not as effective as stimulus control programs or sleep restriction programs.

However, parts of a sleep relaxation program can be combined with other lifestyle/behavior programs to improve treatment results.

Trazadone is an unique antidepressant that is not very good for depression because it makes people sleepy. In low doses, it doesn't have a significant antidepressant effect but is good for sleep problems. Trazadone is sometimes used for insomnia in people who are are on other medications because it has few drug interactions.

It can decrease the period of dream sleep making sleep less restorative and causing daytime grogginess, particularly in the first few days of use. Because dependance does not develop, some experts think it may be safer for long-term use than other sleeping medications although rebound insomnia (worsening of insomnia) may occur once it is stopped. It may be less convenient for short-term insomnia problems, because it needs to be used for several consecutive nights before it starts to work. As opposed to other sleep medications that can be taken sporadically, trazadone must be taken every day to be effective. It is most useful for people who will need long-term drug treatment for their insomnia, particulary those who have other chronic diseases.

Trazadone can rarely (one in ten thousand men) cause a prolonged erection (priapism) so it should be used cautiously in men. This prolonged erection (more than 4 hours) is a medical emergency, and a physician should be seen immediately.

Benzodiazepines are effective for sleep but they interfere with dream sleep, which can make sleep feel less restful.

They can build up in the system, eventually causing daytime problems/drowsiness, and drug dependency can develop with overuse.

Triazolam is better for some people with other medical problems since it wears off quickly, but also has been associated with some unusual behaviors including nighttime sleepwalking (getting into the car to drive while asleep, for example) that caused it to be removed from the market in England. It is still available in the US, but no longer used very often.

One of the longer-acting benzodiazepines (Dalmane) is sometimes used to treat people who have insomnia and also have anxiety during the daytime.

Of this group of drugs, Halcion is relatively short-acting; Restoril and Prosom act for a medium amount of time; and Dalmane is longer-acting (stays in the system for a longer time).

Several studies have found that this type of program can work for individuals with the type of insomnia where falling asleep is the major problem, although paradoxical intention therapy does not appear to be as good as other sleep programs such as "stimulus control therapy" or "sleep restriction therapy".

This program may be useful for people who have trouble falling asleep.

The idea behind paradoxical intention therapy program is to help individuals confront fears about falling asleep by having them intentionally stay awake. Once they see that nothing terrible happens, the theory is that they should be less worried about a lack of sleep (which helps them relax and fall asleep).

These drugs will often make people sleepy and cause side effects such as dry mouth, constipation and problems with passing urine.

The main problem with these medicines is that they stay in the system for up to 8 hours or more, and can make the person feel drowsy the next morning. There are shorter-acting (prescription) drugs that work better.

A type of "talking" therapy (called "cognitive behavioral" therapy) focuses on changing beliefs and misconceptions about sleep. This type of therapy tries to reassure people through education and to calm their anxieties about sleeping problems. Individuals are taught, for example, that a lack of sleep will not seriously affect their health.

Studies suggest that this type of treatment may be very effective. A recent study suggests that behavioral cognitive therapy may decrease the time it takes to fall asleep by approximately 50%. In comparison, in this same study another sleep therapy, "relaxation therapy", only decreased the amount of time it took to fall asleep by 16%.

Melatonin can cause drowsiness but studies have not found that it improves the quality or amount of sleep. Some people think it helps with sleep problems related to jet lag, but no good studies have confirmed this.

Side effects are not common, but this drug should not be given to young or pregnant women because it can cause an imbalance with one of the important female hormones.

L-tryptophan is a natural amino acid (protein building-block) that is found in meats (including turkey) and other foods. It was taken off the market as a supplement because, in higher doses it caused a severe muscle disease in some people. The original high-dose supplement was used for sleep problems. One capsule that contains a lower dose of L-tryptophan is still available, but it has not been studied for safety or to see if it helps with sleep. This treatment is NOT recommended.

Some of the ingredients in this natural supplement probably do cause drowsiness. But its overall effectiveness, how much to take, how long it lasts, and whether or not it is safe to use are all unanswered questions.

Since there are other available drugs that are known to work reasonably well for insomnia, this treatment is not recommended by most experts.

Despite popular thinking that alcohol makes people sleepy, it actually makes the brain more active and can lead to waking up during the night. It also disrupts dream sleep which is the restorative phase of sleep and can lead to daytime grogginess. Alcohol should not be used to treat insomnia.