Sleep Disorders: Treatment

Common Sleeping Problems Find out how you can get a good night's sleep.

More about Sleep Disorders: Definition Causes and symptoms Diagnosis Treatment Alternative treatment Prognosis Resources

Treatment for a sleep disorder depends on what is causing the disorder. For example, if major depression is the cause of insomnia, then treatment of the depression with antidepressants should resolve the insomnia.

Sedative or hypnotic medications are generally recommended only for insomnia related to a temporary stress (like surgery or grief) because of the potential for addiction or overdose. Trazodone, a sedating antidepressant, is often used for chronic insomnia that does not respond to other treatments. Sleep medications may also cause problems for elderly patients because of possible interactions with their other prescription medications. Among the safer hypnotic agents are lorazepam, temazepam, and zolpidem. Chloral hydrate is often preferred for short-term treatment in elderly patients because of its mildness. Short-term treatment is recommended because this drug may be habit forming.

Narcolepsy is treated with stimulants such as dextroamphetamine sulfate or methylphenidate. Nocturnal myoclonus has been successfully treated with clonazepam.

Children with sleep terror disorder or sleepwalking are usually treated with benzodiazepines because this type of medication suppresses stage 3 and stage 4 NREM sleep.

Psychotherapy is recommended for patients with sleep disorders associated with other mental disorders. In many cases the patient's scores on the Beck or Zung inventories will suggest the appropriate direction of treatment.

"Sleep hygiene" or sleep education for sleep disorders often includes instructing the patient in methods to enhance sleep. Patients are advised to:

• wait until he or she is sleepy before going to bed
• avoid using the bedroom for work, reading, or watching television
• get up at the same time every morning no matter how much or how little he or she slept
• avoid smoking and avoid drinking liquids with caffeine
• get some physical exercise early in the day every day
• limit fluid intake after dinner; in particular, avoid alcohol because it frequently causes interrupted sleep
• learn to meditate or practice relaxation techniques
• avoid tossing and turning in bed; instead, he or she should get up and listen to relaxing music or read

Patients with sleep apnea or hypopnea are encouraged to stop smoking, avoid alcohol or drugs of abuse, and lose weight in order to improve the stability of the upper airway.

In some cases, patients with sleep disorders related to jet lag or shift work may need to change employment or travel patterns. Patients may need to avoid rapid changes in shifts at work.

Children with nightmare disorder may benefit from limits on television or movies. Violent scenes or frightening science fiction stories appear to influence the frequency and intensity of children's nightmares.

Although making a surgical opening into the wind-pipe (a tracheostomy) for sleep apnea or hypopnea in adults is a treatment of last resort, it is occasionally performed if the patient's disorder is life threatening and cannot be treated by other methods. In children and adolescents, surgical removal of the tonsils and adenoids is a fairly common and successful treatment for sleep apnea. Most sleep apnea patients are treated with continuous positive airway pressure (CPAP). Sometimes an oral prosthesis is used for mild sleep apnea.

— Rebecca J. Frey