Insomnia from Anxiety

The treatment of anxiety-induced insomnia is mostly the same as the treatment of insomnia. It can be treated in three of the following ways:

• Pharmacologically
• Non-pharmacologically
• Combination of the two

Pharmacological Options to Treat Insomnia from Anxiety

The primary treatment of insomnia is pharmacological because of the speed of action. Pharmacological treatments become effective much faster than non-pharmacy therapy. The most common nonpharmacy therapy, cognitive-behavioral therapy for insomnia (CBT-I) takes considerably longer. The FDA has 11 approved drugs for the treatment of insomnia as of today:

• Nonbenzodiazepines: eszopiclone, zolpidem, zolpidem ER, and zaleplon
• Benzodiazepines: estazolam, flurazepam, quazepam, temazepam, and triazolam
• A tricyclic antidepressant: low-dose Sinequan
• A melatonin agonist: ramelteon

In recent years, nonbenzodiazepines have become the most recommended of the approved hypnotics. Before, benzodiazepine was the most recommended hypnotic, but its reliability has become far lesser than it once was. Nonbenzodiazepines are very effective in treating insomnia (just as effective as benzodiazepines), but there is a notion that they are safer than benzodiazepines.

In the treatment of anxiety-induced insomnia, insomnia should be treated side by side of the anxiety disorder, but independently. Meaning, do not consider the medical condition as one but as two separate disorders. Before people would only treat the anxiety disorder and wait to see if the insomnia was treated with that, but this method is no longer valid because clinical experience has shown that without targeting insomnia treatment, insomnia frequently stays and does not go.

Around 50% of patients with insomnia continue to have insomnia 3 years after initially being diagnosed with the disorder. Many patients require months or even years of treatment. Nonbenzodiazepines for primary insomnia are found to have continued success and to be well tolerated with no evidence of abuse or withdrawal symptoms after stopping its use after 12 months. Ramelteon is also found to be effective and successful with no major issues of abuse or tolerance.

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In some patients with insomnia, benzodiazepines are definitely necessary. The other hypnotics possibly will not give the same effect for some patients. In this case, the anxiolytic properties of benzodiazepines could be helpful.

When hypnotics are used, their use needs to be checked every 3 to 4 weeks. Many patients with insomnia do not have sleep disturbances nightly. Therefore, the use of hypnotics on a requirement basis or a few times a week helps reduce the amount and exposure to the medication.

Non-pharmacological options

The first option we recommend is CBT-I. CBT-I is an important, widely accepted, treatment for insomnia. It is the best-studied of the nonpharmacological approaches for this disorder and is a manualized treatment that focuses on various components of CBT, which are cognitive restructuring and the use of psychological interventions. These strategies address negative and mutilated cognitions and behaviors that start and sustain sleep deprivation. The time required for treatment is rather short. It is managed for 5 hours divided over 4 to 6 weeks and can hence be utilized as an upkeep treatment in the month to monthly sessions. There are about 12 well-designed CBT-I trials that have clearly illustrated that it may be a profoundly compelling mediation for insomnia for 1 year or longer.

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Studies that compared CBT-I with pharmacotherapy found identical adequacy. In contrast to hypnotics, learned CBT-I skills may continue even when active treatment ends. Furthermore, a few patients may favor CBT-I over hypnotic drugs since their conceivable antagonistic impacts or concerns about drug use or taking a drug amid pregnancy.

In general, CBT-I is not used enough. Only around 1% of patients with chronic insomnia decide to use this therapy. To increase the availability and use of CBT, it can be managed by means of self-help procedures and in a group format. However, it has been seen to be effective in providing CBT through the use of the internet. In most cases, patients often incline towards face-to-face contact.

A few other non-pharmacological therapies other than CBT-I have also been used to treat insomnia, such as bright light, physical exercise, acupuncture, tai chi, and yoga. Sadly, the results have not been up to standards and have been inconsistent.

Combination Therapy

A combination of pharmacotherapy and non-pharmacotherapy may or may not be more effective than either of the two types of treatments alone to cure anxiety disorders with insomnia. Combination therapy has not been addressed in studies of this particular patient population. The question has not been addressed very often, even in the treatment of insomnia. Studies find only mild differences in outcomes with a combination of therapies. The same types of results were seen in a study that compared CBT with CBT plus zolpidem. The 6-week short study illustrated a 60% successful reaction rate and a 40% remission rate; the group that was treated with the combination treatment had a significant increment to their sleep time of 15 minutes, but the analysts did not like this difference and did not find it clinical enough.