Insomnia is the inability to initiate sleep and or maintain sleep. It can be primary or secondary. Primary is an independent entity by itself and secondary due to psychological and social stressors, medications or medical and psychiatric disorders. The diagnosis of insomnia is based on the clinical history the patient provides.
Our approach to insomnia at the NMI is multidisciplinary focusing on behavioral and pharmacological therapies. Behavioral treatment include improving sleep hygiene including maintaining regular sleep hour, sleep deprivation, avoidance of any stimulants (caffeine, stimulant medications), alcoholic drinks, psychological and social stressor, watching television in the bedroom. Another focus of the NMI is cognitive behavioral therapy and to treat secondary causes of insomnia including depression, anxiety and other medical and psychiatric disorders.
Pharmacological approach is a stepwise starting with melatonin and moving up to hypnotics such as Zolpidem (Ambien, Ambien CR), Ramelteon (Rozerem), Eszopiclone (Lunesta), temazepam (Restoril), clonazepam (Klonopin), alprazolam (Xanax) and antidepressants (doxepin, trimipramine, amitriptyline, and mirtazapine).
There are other types of insomnia that we diagnose and treat at the since the treatment differs from one to another.