Insomnia affects 30% of Americans. Poor quality or too little sleep can negatively impact quality of life. It can also decrease productivity, increase drowsiness and fatigue and can worsen other health issues.

Initial treatment focuses on lifestyle modification. This includes cognitive behavior therapy to decrease negative thought patterns that disrupt sleep. There are five elements to cognitive behavior therapy for insomnia: cognitive restructuring, stimulus control, sleep hygiene (no naps or caffeine or alcohol), relaxation therapy (progressive muscle relaxation and reducing mental activity and physician tension before bed), and sleep restriction (so that the patient has a consistent wake-up time for getting out of bed consistent with total time spent in bed—- don’t linger in bed). This restructuring can help reduce anxiety about inadequate sleep and its consequences. Expectations are for patients to sleep for 5-6 hours per night. Decreased stimuli near bedtime (blue lights, TV, exercise). Use relaxation techniques and mindfulness exercises.

If these are ineffective, medications can be used. Most physicians avoid benzodiazepines and “Z-drugs” (like Zolpidem, Zaleplon, or Eszopiclone) because there are short-and long-term risks associated with use of these medications. Z drugs are considered nonbenzodiazepine hypnotic medications. Some patients perform complex sleep-related behaviors like sleepwalking and sleep eating. The US Drug Enforcement Administration has classified both drug classes as schedule IV drugs requiring medication monitoring with periodic urine drug screening and tracking prescriptions of controlled substances.
Melatonin receptor agonists are safer and well-tolerated, but some patients find that they are not very effective. Ramelteon is a melatonin-receptor agonist that helps with sleep onset. Melatonin 1-3 mg is available over the counter.

Orexin receptor antagonists can help with sleep onset and sleep maintenance. You may have seen advertisements for these: Daridorexant, Lemborexant, or suvorexant (Quivivq, Dayvigo, or Belsomra). These medications can cost $300-500 per month. The most common side effect of this class of medication is daytime sleepiness.

I hope this helps.