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Q: How are sleep problems treated?
A: Throughout this content, each sleep problem has been dealt with in turn and specific treatments have been outlined. Treatments can include simple lifestyle changes, behavioral changes, talking therapies, medication, mechanical treatments, surgical treatments, dental treatments, light therapies, and complementary therapies. Sometimes a combination of several therapies is necessary.
Q: What is meant by lifestyle changes?
A: Making lifestyle changes involves examining the daily patterns of your life and changing/modifying them if they are not producing the desired results. Lifestyle includes all the factors that make up your life and the way you run it, such as diet, exercise, sleep-wake routine, work, leisure, and relationships.
Q: What is meant by behavioral approaches to treating a sleep problem?
A: Behavioral techniques used to modify or change sleep behavior (usually in the treatment of insomnia) include sleep hygiene, relaxation exercises, and techniques for reducing recurrent and persistent thoughts during sleep. These include cognitive focusing, sleep restriction therapy, and systematic desensitization.
Q: What is cognitive focusing?
A: This is the technique of focusing on pleasant thoughts and images when awakening at night. It is useful in the treatment of insomnia, especially in situations where the person wakes up during the night with negative thoughts that prevent him or her from getting back to sleep again.
Q: What is sleep restriction therapy?
A: This is one treatment that can be of use in insomnia, when too much time is spent in bed but not enough of that time is spent asleep. People with this problem often end up going to bed early on some nights and late on others with the result that they end up with a very disrupted and inefficient sleeping pattern. The treatment involves reducing the amount of time spent in bed by an hour or more initially and going to bed at set times and getting up at set times. This helps consolidate sleep and strengthen circadian rhythms.
Q: What is systematic desensitization?
A: This technique is very useful in people whose insomnia is related to anxiety and who associate negative thoughts with their bedtime routine. The person is asked to make a list of the negative thoughts and experiences associated with getting to sleep. The person then concentrates on associating pleasant ideas with the bedtime routine until it no longer becomes anxiety-inducing.
Q: Which medications are commonly prescribed for sleep disorders?
A: The type of medication prescribed for your sleep disorder will differ depending on whether the problem is acute or chronic and whether it is potentially medication-responsive or not. There are many different classes of drugs that act on very different pathways in the brain. Probably the most commonly prescribed drugs are sedative drugs from the benzodiazepine and related classes. Some of the other drugs listed in Commonly prescribed medications for treating adult sleep disorders are used exclusively for the treatment of excessive daytime sleepiness, such as modafinil, while others are used to treat a variety of disorders such as depression and anxiety (tricyclic antidepressants), and L-dopa is used to treat Parkinson’s disease as well.
Q: What does the term “talking therapies” encompass?
A: Talking therapies involve counseling using techniques ranging from psychodynamic psychotherapy to cognitive-behavioral therapy (CBT). CBT is one of the most effective forms of psychotherapy, and deals specifically with issues that are causing problems in the patient’s life such as self-esteem, anxiety, problems with coping, low mood, or self-defeating behavior. CBT involves the patient identifying the behavior, rating how he or she feels about it (anxious, stressed, depressed), and then challenging that feeling with rational thought. Once the feeling is challenged and more realistic alternative viewpoints are brought into play, the patient is then asked to again rate feelings again about coping with the situation.
Q: What is meant by mechanical treatments for sleep disorders?
A: Mechanical treatment of sleep disorders encompasses the use of continuous positive airway pressure (CPAP) for sleep-disordered breathing or bilevel ventilation devices in patients with respiratory failure .
Q: How applicable are dental and surgical treatments to sleep disorders?
A: Surgery may help patients with sleep apnea who have a correctable facial, jaw, or tongue abnormality. Dental treatments for sleep apnea and snoring are mandibular repositioning devices or mouthguard devices that are fitted to the upper and lower jaws. Mouthguards are useful in the treatment of bruxism or tooth-grinding during sleep.
Q: How do I undertake light therapy?
A: Light therapy is used to treat both circadian rhythm disorders and SAD . It involves exposure to a lightbox at 10,000 lux for 30–60 minutes depending on the strength of light. Lightboxes can be bought easily, especially online. 
Q: Are complementary therapies effective in the treatment of sleep disorders?
A: Personal anecdotes suggest that herbal, homeopathic, and other complementary therapies such as reiki and hypnosis may be useful at times or even as adjuncts to other forms of therapy in the treatment of sleep problems. They are probably the most helpful when it comes to lifestyle problems involving the reduction of stress and anxiety levels. They may have a small role to play in dealing with insomnia. However, there is very little evidence from properly conducted trials on their true efficacy.

Commonly prescribed medications for treating adult sleep disorders

A large number of medications are used in the treatment of a variety of sleep disorders. They are listed , but they must be prescribed by your doctor.

Table
Sleep problemMedicationDrug class
Cataplexy; depressionImipramineTricyclic antidepressant
EnuresisDesmopressinHormone (ADH) analog
Parasomnias; seizuresClonazepamBenzodiazepine
SedationLorazepamBenzodiazepine
Sedation; phase advanceMelatoninHormone
SedationZaleplonNonbenzodiazepine
SedationZolpidemNonbenzodiazepine
SedationZopicloneNonbenzodiazepine
SedationTemazepamBenzodiazepine
NarcolepsyModafinilStimulant
NarcolepsyDexamphetamineStimulant
NarcolepsyMethylphenidateStimulant
CataplexyClomipramineTricyclic antidepressant
Depression; cataplexySertralineSelective serotonin reuptake inhibitor (SSRI)
Depression; cataplexyFluoxetineSSRI
Restless legs syndromeCodeineOpioid analgesic
REM-behavior disorder; Parkinson’s diseaseL-dopaDopamine agonist
Restless legs syndromeRopiniroleDopamine agonist

Relaxation techniques for getting to sleep

There are many different relaxation techniques and you should choose one that suits you. Some people find meditation useful, while others enjoy yoga or tai chi. People with very high muscle tension may find it useful to do the progressive relaxation exercise first described by Edmund Jacobsen in 1983.

This exercise is intended to relax step-by-step all the different groups of muscles in the body. It involves lying on the floor on your back with legs uncrossed and out straight, and arms down by your sides. Your eyes should be closed. The exercises should last about 30–60 minutes, depending on the degree of muscle tension present, but can be abbreviated. Each muscle group in turn is tensed, then suddenly allowed to go limp, followed by relaxation for a couple of minutes. Start at your feet and gradually work up your body, tensing and relaxing each large muscle group in turn until you reach your head.

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