If you think you have insomnia, talk to your health care provider. An evaluation may include a physical exam, a medical history, and a sleep history. You may be asked to keep a sleep diary for a week or two, keeping track of your sleep patterns and how you feel during the day. Your health care provider may want to interview your bed partner about the quantity and quality of your sleep. In some cases, you may be referred to a sleep center for special tests.

Transient and intermittent insomnia may not require treatment since episodes last only a few days at a time. For example, if insomnia is due to a temporary change in the sleep/wake schedule, as with jet lag, the person's biological clock will often get back to normal on its own. However, for some people who experience daytime sleepiness and impaired performance as a result of transient insomnia, the use of short-acting sleeping pills may improve sleep and next-day alertness. As with all drugs, there are potential side effects. Anyone taking sleeping pills should be under close supervision to evaluate the effectiveness and side effects of the drug. Doctors will usually give you the lowest dose possible to relieve your symptoms.

The rapid onset, short-acting medications now available avoid many of the earlier problems with continuing effects (like feeling drowsy or groggy) the following day. Some medications may be less effective after several weeks of nightly use, however, and long-term safety and effectiveness has not yet been established. Side effects of sleeping pills (and over-the-counter sleep medicines) can be a problem, too. Mild insomnia often can be prevented or cured by practicing good sleep habits.

If your insomnia still isn't going away, keep a diary of your sleep history. A doctor may also want to interview your partner about the quantity and quality of your sleep. Your doctor will want to diagnose and treat any underlying medical or psychological problems, such as depression, and identify behaviors, like caffeine consumption or TV-watching, that may worsen the insomnia.

Treatment for chronic (long-term) insomnia includes first treating any underlying conditions or health problems that are causing the insomnia. If insomnia continues, your health care provider may suggest behavioral therapy or medication. Most medicines that are used for sleep have side effects and must be used with caution. Behavioral approaches to treatment focus on changing behaviors that may worsen insomnia and learning new behaviors to promote sleep. Treatment for chronic insomnia usually consists of:

• First, diagnosing and treating underlying medical or psychological problems.
  
• Identifying behaviors that may worsen insomnia and stopping (or reducing) them.
  

• Possibly using sleeping pills, although the long-term use of sleeping pills for chronic insomnia is controversial. A patient taking any sleeping pill should be under the supervision of a physician to closely evaluate effectiveness and minimize side effects. In general, these drugs are prescribed at the lowest dose and for the shortest duration needed to relieve the sleep-related symptoms. For some of these medicines, the dose must be gradually lowered as the medicine is discontinued because, if stopped abruptly, it can cause insomnia to occur again for a night or two.
  

• Trying behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, and reconditioning.

Relaxation Therapy. Relaxation therapy relaxes your mind and muscles. There are a few different techniques, but they all focus on non-directed relaxation. Patients focus on the repetition of a word, sound or muscular activity, without actively excluding other thoughts or feelings. The focus is on passively relaxing by accepting each thought or feeling. There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, the person's mind is able to stop "racing," the muscles can relax, and restful sleep can occur. It usually takes much practice to learn these techniques and to achieve effective relaxation.

Sleep Restriction. Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night's sleep is achieved.

Reconditioning. Another treatment that may help some people with insomnia is to recondition them to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy, and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the person's body will be conditioned to associate the bed and bedtime with sleep.