How to Treat Patients with Insomnia
Thomas Roth, PhD, Henry Ford Hospital
Insomnia can be considered a disorder of hyperarousal; patients “can’t shut their brain off.” An important criterion for insomnia is that sleeplessness occurs despite adequate opportunity and circumstances for sleep; otherwise, the problem is just considered poor sleep. Dr. Roth recommends performing a thorough sleep hygiene assessment using the mnemonic LEARNS (Light, Environment, Activity, Routine, Napping, Substances). Behavioral interventions include stimulus control therapy, sleep-restriction therapy, relaxation therapy, and cognitive therapy for insomnia. All FDA-approved benzodiazepine receptor agonists work on GABAA receptors; therefore, the difference among them is half-life. Suvorexant, an orexin agonist, targets the brain’s arousal system and improves sleep onset and sleep maintenance.
