Last year a new sleep drug called Belsomra came on the market, featuring a mechanism unlike any other pill: it mimics narcolepsy. That might sound odd, but the potential users are many. More than 8.5 million Americans take prescription sleep aids, and many others use snooze-inducing over-the-counter medications. All these pills, including Belsomra, do one of two things: they enhance the effects of the neurotransmitter GABA, known for quieting brain activity, or they arrest the actions of neurotransmitters that keep the brain aroused. Yet it's not quite as simple as flipping a switch; the drugs have a range of side effects, including daytime drowsiness, hallucinations and sleep-eating. Here's an overview of the sleeping pills currently available in the U.S.—plus a look at cognitive-behavior therapy for insomnia, which may be more successful than drugs alone.


Sleep Training for Grown-ups

It requires a lot more work than popping a pill, but cognitive-behavior therapy for insomnia (CBT-I) has been shown to successfully alleviate sleep problems. Aimed at developing healthy habits, CBT-I comes with a lot of homework—between weekly or so visits with a specialist, a patient keeps track of hours spent in bed and hours sleeping and uses the bed only for sleep and sex. The patient must stay up until an established bedtime and get up on awakening, generating a sleep deficit that makes it easier to fall asleep at the right time. Avoiding caffeine and alcohol after 4 P.M. and timing exercise so that it doesn't interfere with drowsiness are also part of the system.

Therapists will work on the cognitive aspects of insomnia, helping people recognize that a sleepless night is not the end of the world and teaching relaxation techniques that can help alleviate worry in the middle of the night. Many studies support the efficacy of this type of CBT. In one study, six months after a six-week CBT-I treatment patients were spending much more of their time in bed asleep than patients who took a z-drug instead.

“Many people, perhaps most people, with insomnia don't have anything wrong with their sleep-promoting mechanisms,” says Tom Scammell, a sleep medicine doctor at Beth Israel Deaconess Medical Center in Boston. “They have quite often a problem with their wake-promoting mechanisms.” In other words, activities during the day or evening—eating or drinking habits, say, or too much mental stimulation at bedtime—are causing the brain to remain alert. Getting the balance back—learning to put problems aside at the end of the day and give in to sleep—can help bring rest within reach, night after night.