The first step is to diagnose any underlying causes and treat the condition. For example, if insomnia is being caused by depression; once the depression is treated, the insomnia will often disappear without further medical help.

Non-drug treatments are usually the preferred first course of action. These treatments can include:

• Counselling, if the insomnia is related to bereavement or stressful life events etc.
• Cognitive behavioural therapy (altering behaviour and thinking patterns).
• Problem-solving approaches to make you feel in control (for example, keeping a sleep diary).
• Lifestyle advice. This includes restricting caffeine, nicotine, and alcohol; taking regular exercise; keeping regular times for sleeping and waking; maintaining good sleeping environment.
• Education about sleep and relaxation.

Sleeping tablets

Sleeping tablets may be considered:

• if your symptoms are particularly severe,
• to ease short-term insomnia, or
• if the non-drug treatments mentioned above have failed to have an effect.

However, doctors are usually reluctant to prescribe this type of medication as they relieve symptoms but do not treat the cause of sleeplessness. If you experience long-term insomnia, sleeping tablets are unlikely to help and your doctor may consider referring you to a clinical psychologist to discuss other approaches to treatment.

Short-acting benzodiazepines or the newer hypnotic 'Z medicines' are the current preferred medicines for insomnia and are only available on prescription.

Benzodiazepines

Benzodiazepines are tranquillisers and are designed to reduce anxiety and promote calmness, relaxation and sleep. They work by slowing the body down. These medicines should only be considered if your insomnia is severe or causing you extreme distress. All Benzodiazepines have hypnotic effects and can lead to a dependency. If they are to be used to treat insomnia then only the short-acting benzodiazepines should be prescribed, such as:

• Temazepam,
• Loprazolam, and
• Lormetazepam

Z medicines

Z medicines are another type of sleeping tablet that work in a similar way to Benzodiazepines. They are also short acting medicines and include:

• Zopiclone,
• Zolpidem, and
• Zaleplon

There is little difference between the Benzodiazepines and Z medicines and so if one does not work it is unlikely that swapping to another will have a different effect.

Hypnotics

Hypnotic medicines should only be used in cases when the expected period of treatment will be short term. For example during an illness, or an overnight stay in a busy hospital ward or because of jet lag.

You should be given the smallest, effective dosage possible for the shortest length of time necessary, e.g. for a week at the most. In some cases, your doctor may advise that you only take the medication 2 or 3 nights a week, rather than every night.

These hypnotic medicines have side effects related to the desired effect they have on your sleep pattern and may cause:

• a kind of drug-induced hangover,
• drowsiness during the day,

It is best to take the medicines at night- time before you go to bed. In some people, especially older people, the hangover effects may last into the next day and so you should be cautious if you are likely to be driving the next day.

It is very easy to become dependant on these medicines, even after a short term course and you should take note of any possible side effects before starting treatment. If you start treatment in hospital during a short stay, you should not automatically continue when you leave. Speak to a doctor for advice.

If you are regularly taking sleeping tablets every night, you should consider reducing or stopping them. You are advised not to stop taking the medicine suddenly as withdrawal symptoms can include panic attacks, shaking and rebound insomnia. Speak to your doctor for advice.

Melatonin

Medicines containing melatonin have been shown to be effective in providing short-term relief for insomnia. Melatonin is a naturally occurring hormone that helps regulate the sleep cycle (circadian rhythm).

At present, the only licensed medicine for the treatment of insomnia that contains melatonin is called circadin. Circadin is only available on prescription for people who are aged 55 or over.

Circadin is only designed as a short-term treatment for insomnia and should not be taken for more than three weeks.

Circadin is not recommended for people with a history of kidney or liver disease.

As yet, there is not enough evidence to say whether it is safe to take circadin during pregnancy or when breastfeeding, so its use is not recommended in these circumstances.

As circadin can make your drowsy you should not drive or operate heavy machinery after taking the medicine at night, or if you still feel drowsy the next morning.

Side effects of circadin are uncommon and include:

• irritability,
• dizziness,
• migraines,
• constipation,
• abdominal pain, and
• weight gain.

If you find these side effects troubling you should stop taking circadin and contact your GP.

Other medicines

Other types of medicines, including barbiturates, sedative antidepressants, and antipsychotic medicines, should not be used to treat insomnia. These medicines are used to treat other conditions and their sedative effects may be helpful to the person who has been prescribed the medicine but are not suitable for treating short-term insomnia on its own..

Antihistamines can be bought over the counter at pharmacies and certain preparations have been sold for their sedative properties, but they have not shown to be of much benefit.

Certain herbal remedies such as, chamomile and passionflower have had some reported positive effects but have not been thoroughly clinically investigated to support their use and long term safety