1.Set a regular time to go to bed and a regular time to wake up:

Regularity is a key component to improving sleep. The patient must set these times and adhere to them as diligently as possible. A patient who cannot fall asleep within a reasonable period of time should get out of bed, leave the bedroom, and do something non-stimulating, for some this would be watching a late night talk show on television and for others it might be reading one's professional journals. After 30 to 60 min, another attempt should be made to fall asleep. The idea is to not spend too much time in bed awake; an association between the bed and an inability to fall sleep can simply compound the problem. At least as important is the establishment of a regular wake-up time. No matter how long it took to fall asleep, no matter how little sleep the patient has had, and no matter how flexible the morning schedule is, there should be no "sleeping in." This would only further confuse and disorganize the internal biological clock (i.e., the circadian pacemaker).

2. Make the sleep environment as comfortable and secure as possible:

The patient should attempt to see that the bedroom is dark and quiet,and is neither too hot nor too cold. Although minor fluctuations in room temperature and firmness of the mattress probably have little impact on sleep, extremes can be disturbing. A sense of security can be important especially to the elderly, who may feel more vulnerable to intruders or who may be increasingly concerned as old neighborhoods change.

3. Omit alcohol and caffeine in the late afternoon and evening:

Each individual must discover how late such ingestion can be tolerated. However, for the very sensitive, caffeine intake may need to be discontinued each day by noon. Although alcohol is often used as a self-treatment for relaxation and sleep induction, the patient must be told about the rapid elimination of the substance during the first half of the night, resulting in some degree of withdrawal, characterized by increased dreaming and nightmares as well as a general disruption of sleep, during the latter half.

4. Develop a sleep habit or ritual and use the bedroom primarily as a place to sleep:

Although many of us, while in bed, use the bedroom for watching television, preparing work for the following day, eating snacks, and paying bills, the individual with a sleep problem needs to set the bedroom aside for sleep only. (Sexual activity may be an exception.) Just as warm milk and cookies become a ritual for some children prior to bedtime, some adults must develop a similar relaxing ritual that can be a part of the stimulus for a sleep response.

5. Carefully time meals and exercise:

A heavy meal late in the evening can severely disrupt sleep in the patient with gastroesophageal reflux. Heavy exercise too late in the evening can also lead to a worsening of sleep in all but the best-conditioned athlete; therefore, for most of us, heavy exercise should Ix1 scheduled earlier in the day.

6. Relaxation techniques or hypnosis may be useful:

Some people simply need to be able to relax sufficiently to allow sleep to occur. Perhaps on the counter displaying all of the nonprescription sleep aids, there should be available relaxation tapes as well.

7. Consider psychotherapy:

Since at least 35% of all patients seen in sleep-disorders centers for a complaint of insomnia have an identifiable psychiatric- or psychological cause, some form of psychotherapy or psychiatric treatment should be considered.

Some general rules of sleep hygiene can be recommended for both persistent and transient insomnias. In addition, other nonpharmacologic approaches are available. These include desensitization, meditation, bio-feedback, stimulus control, and others .There are, however, times when hypnotics should be and are appropriately used.

The persistent insomnias associated with major psychiatric disorders are most appropriately treated with the specific class of agents targeted for the particular disorder.

For the psychotic patient, selection and titration of an antipsychotic would be the most appropriate treatment. If the insomnia is associated with drug dependence or drug withdrawal, gradual tapering of the offending agent or the equivalent amount of a cross-tolerant long-acting agent is the primary treatment. If the insomnia is associated with a stimulant, in many cases the agent should simply be discontinued abruptly abruptly and no more delay to discuss everything with your physician/ psychiatrist.