[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › Insomnia: types and management # Insomnia: types and management Why people sleep badly, why behavioural therapy comes first, and when and how sleep medicines are used. Updated Nov 12, 2026 Insomnia is difficulty falling asleep, staying asleep or waking too early, with daytime impairment. It is often linked with stress, anxiety, depression, shift work, alcohol, caffeine or another illness. Long-term insomnia is treated first with cognitive behavioural therapy for insomnia (CBT-I); hypnotics have a limited, short-term role. ## Key points - Short-term insomnia lasts less than three months; long-term (chronic) insomnia lasts three months or more. - CBT-I is the first treatment for long-term insomnia. - Underlying causes (stress, depression, anxiety, other illness, alcohol, caffeine) are looked for and treated. - Hypnotics are used at the lowest effective level for the shortest time; long-term use loses effect and can cause rebound insomnia. - Older adults are more sensitive to hypnotics, with more daytime impairment and falls. ## Types of insomnia - Short-term: usually triggered by a situational stressor such as illness, grief or job problems. - Long-term: lasting three months or more, often maintained by conditioned (learned) habits and worry about sleep. - Comorbid: linked with depression, anxiety, another medical illness, shift work, or caffeine, nicotine and alcohol. ## Cognitive behavioural therapy for insomnia CBT-I runs over several weeks, in person, by phone or online. It combines sleep education, stimulus control (using the bed only for sleep), sleep restriction (matching time in bed to actual sleep), relaxation or meditation, and cognitive work on unhelpful beliefs about sleep. It addresses the learned (conditioned) habits that keep long-term insomnia going, whereas long-term hypnotic use tends to lose effect. ## Sleep hygiene - Regular sleep and wake times, including weekends. - A cool, dark, quiet bedroom and no screens before bed. - Less caffeine, nicotine and alcohol, especially in the evening. - Daytime exercise, and no late naps or heavy late meals. ## Hypnotic medicines - Z-drugs (zolpidem, zopiclone, eszopiclone, zaleplon): act at the benzodiazepine site of GABA-A receptors; can rarely cause complex sleep behaviours such as sleepwalking or driving while asleep. - Benzodiazepines: reserved for when other options fail; habit-forming, so only for a few weeks. - Orexin receptor antagonists (suvorexant, lemborexant, daridorexant): block wake-promoting orexin; not for people with narcolepsy. - Melatonin receptor agonists (ramelteon): can cause dizziness and fatigue; over-the-counter melatonin supplements have not been proven effective for insomnia. - Sedating antihistamines (over the counter): can cause next-day drowsiness and are unsafe for some people. ## Choosing and stopping Drug choice depends on whether the problem is falling asleep or staying asleep, how long the effect lasts into the next day, other illnesses and the risk of misuse. Combining sedatives such as benzodiazepines with opioids or other CNS depressants increases the risk of breathing depression. Older patients clear many benzodiazepines more slowly, so they face more daytime cognitive impairment and falls; older agents such as barbiturates are avoided. Stopping after long use is done gradually to limit rebound insomnia and withdrawal. ## Test yourself Think of the answer, then tap the question to see it. ## What is the first treatment for long-term insomnia? Cognitive behavioural therapy for insomnia (CBT-I), a programme of several weeks combining sleep education, stimulus control, sleep restriction, relaxation and cognitive therapy. ## What does sleep restriction mean in CBT-I? Limiting time in bed to the time actually spent asleep, then extending it as sleep becomes more efficient. ## How do orexin receptor antagonists promote sleep? They block orexin, a wake-promoting neuropeptide, instead of enhancing GABA-A inhibition. ## Why are benzodiazepine hypnotics a particular risk in older adults? Slower elimination and greater sensitivity lead to daytime cognitive impairment and falls. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/topics/insomnia-types-and-management/) [More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology) ## Example drugs - [Zolpidem](https://durgical.com/en/pharmacology/zolpidem/) - [Zopiclone](https://durgical.com/en/pharmacology/zopiclone/) - [Eszopiclone](https://durgical.com/en/pharmacology/eszopiclone/) - [Suvorexant](https://durgical.com/en/pharmacology/suvorexant/) - [Lemborexant](https://durgical.com/en/pharmacology/lemborexant/) - [Daridorexant](https://durgical.com/en/pharmacology/daridorexant/) - [Ramelteon](https://durgical.com/en/pharmacology/ramelteon/) - [Melatonin](https://durgical.com/en/pharmacology/melatonin/) - [Trazodone](https://durgical.com/en/pharmacology/trazodone/) ## Connections ## Related classes 3 - [Z-drug hypnotics](https://durgical.com/en/pharmacology/classes/z-drug-hypnotics/) - [Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/) - [Other hypnotics (melatonin agonists and orexin antagonists)](https://durgical.com/en/pharmacology/classes/other-hypnotics/) [← All of pharmacology](https://durgical.com/en/pharmacology/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [Insomnia - Treatment | NHLBI, NIH](https://www.nhlbi.nih.gov/health/insomnia/treatment) (National Heart, Lung, and Blood Institute, 2026); [Insomnia - NHS](https://www.nhs.uk/conditions/insomnia/) (NHS (UK), 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/topics/insomnia-types-and-management/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/topics/insomnia-types-and-management/