Because many factors influence the sleep-wake cycle, treatment must be individualized according to the patient's specific symptoms and findings from the patient's evaluation. Several generalizations are possible.
Implementation of good sleep habits and daily physical activity should help create an environment conducive to restorative sleep. Even if poor sleep habits are not responsible for insomnia, elimination of such habits can minimize their perpetuating influence.
Daily exercise and exposure to daylight can help reinforce the circadian cycle. These measures have the greatest potential for improving the quality of sleep in elderly persons. Exposure to bright light for 30 to 60 minutes in the evening may benefit patients with early bedtimes who complain of early-morning awakening.
Patients may be advised to avoid going to bed until they feel as though they can easily fall asleep. An extended wakeful time in bed (e.g., more than 30 minutes) should be avoided to minimize further reinforcement of hyperarousal. In addition, patients should plan relaxing nighttime activities before bedtime.
Low dosages of sedating antidepressants are especially helpful in patients with depressive symptoms. While potentially valuable in offering relief of insomnia, hypnotic agents should not be regarded as the ultimate solution to a sleep problem.
They should be used under limited circumstances, following evaluation of the patient's symptoms and in the context of good sleep habits. Consultation with a sleep disorders specialist should be considered in patients with marked daytime sleepiness, because this symptom can be dangerous.
Guidance regarding the management of chronic insomnia and sleep-related behavioral problems also may be obtained from a sleep disorders specialist. Formal sleep studies are appropriate when a primary sleep disorder is suspected.