Dr. Stephen Amira describes the two different types of treatment strategies for insomnia.
There are two major treatments of insomnia. The preferred treatment is through adopting behavioral strategies to improve sleep, in particular Cognitive Behavioral Therapy for Insomnia (CBTI). The other strategy is to use medications to improve sleep. You may wonder if you should use behavioral treatments, medications, or both. Here are some things to keep in mind:
Hypnotics, or sleep-inducing drugs, can be effective in treating insomnia.
Studies show that CBTI and hypnotics are initially equally effective1
Effects of CBTI are longer lasting. The changes in sleep go beyond the resolution or improvement of sleep.
Hypnotics act quicker than CBTI. You take the pill, then you go to sleep. However, if you stop taking the medication, its effects can later diminish. If you or someone you know has become dependent on sleeping pills due to the recurrence of insomnia, please visit: https://www.addictioncenter.com/sleeping-pills/ or call (888) 655-1023 for anonymous help.
Combination therapy of CBTI and hypnotics has not been shown to be better than CBTI alone. Studies also show that hypnotics do not appear to affect the response to CBTI
Some studies show an increased risk of dementia with long-term use of hypnotics1
Remember that results will vary. Treatment decisions will differ and need to be discussed with your provider.
What about Melatonin?
As mentioned previously, melatonin is a hormone produced in our bodies. It is released by a gland enclosed in the brain known as the pineal gland. An increase in melatonin near bedtime signals to the brain that it is time for sleep. The best use of melatonin supplements is as a sleep aid for circadian rhythm problems rather than insomnia. Moreover, the AASM guidelines recommend against use of melatonin for insomnia.
Despite this fact, many people take melatonin supplements in hopes that it will help them fall asleep. The lack of federal regulation on supplements means that different brands of melatonin can have significantly different amounts of melatonin content2. Before taking melatonin, talk with your provider to see if it is right for you.
Sutton, E. L. (2021). Insomnia. Annals of Internal Medicine, 174(3). doi:10.7326/aitc202103160
Erland, Lauren AE, and Praveen K. Saxena. "Melatonin natural health products and supplements: presence of serotonin and significant variability of melatonin content." Journal of Clinical Sleep Medicine 13.2 (2017): 275-281.