Chronic insomnia: the most effective treatment is not pills

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Portugal has an odd relationship with sleep: it is among the worst-sleeping countries in Europe and, at the same time, among the biggest consumers of sleeping medication. The two are connected — though not in the way people assume. Pills relieve nights; they do not treat insomnia.

Why pills do not solve it

Benzodiazepines and similar drugs induce sleep, but they do not correct the mechanisms that keep insomnia going: irregular hours, the learned association between bed and worry, performance anxiety ("what if I cannot sleep tonight either?"). So when the medication stops, insomnia usually returns — sometimes worse, with the added tolerance and dependence these drugs can create when used over months.

What international guidelines say

The main scientific bodies — from European sleep societies to American guidelines — agree: the first-line treatment for chronic insomnia is Cognitive Behavioural Therapy for Insomnia (CBT-I), not medication. Medication has a place in short, acute phases, ideally with an exit plan defined from the outset.

How CBT-I works

• Sleep diary and sleep restriction — reorganising time in bed to rebuild natural sleep pressure (it is counterintuitive: sleeping better starts with spending less time lying down).
• Stimulus control — retraining the brain so that bed means sleep again, rather than worry, screens or struggle.
• Cognitive work — dismantling the beliefs that feed sleep anxiety ("I need 8 hours or tomorrow is a disaster").
• Relaxation and downregulation — techniques to lower the alert state; clinical hypnotherapy can be a useful complement here.

And if you have been taking pills for years?

Do not stop on your own — abrupt withdrawal can cause rebound insomnia and other effects. The safe route is to do CBT-I and, alongside it, reduce medication gradually under medical supervision. That combination is exactly what the HICOA Clinic team offers, bringing together psychology, hypnotherapy and psychiatry.