Millions of Americans might be overusing sleeping pills, which can pose health risks, a recent analysis by Consumer Reports Best Buy Drugs noted. Medication for insomnia can lead to side effects, dependency and even worse sleep problems when taken too often or in excessive doses. If you need help for short-term insomnia caused by travel or a stressful event, start with an over-the-counter sleep aid. If that doesn’t work, ask your doctor if you should try generic zolpidem. But everyone — especially those with chronic insomnia and people 55 or older — should first try these nondrug approaches:

Lifestyle changes. Behavior modification — such as changing sleep habits by getting up at the same time every day and avoiding naps — produced significant improvements for older adults with chronic insomnia, according to a 2011 study published in the Archives of Internal Medicine.

Cognitive-behavioral therapy. Seeing a therapist who specializes in insomnia might help 70 to 80 percent of people with chronic insomnia, often providing a “cure.” (Pills treat the symptoms.) To find a sleep center where CBT is offered, call the American Academy of Sleep Medicine at 630-737-9700 or go to www.sleepcenters.org. Ask your insurer about coverage.

For people with sleep problems, pills are not the only treatment worth considering. (istock)

Exercise. A study of more than 3,000 adults, published in December in the journal Mental Health and Physical Activity, found that 150 minutes a week of moderate exercise, such as brisk walking, or 75 minutes a week of vigorous activity, such as running, improved sleep quality by as much as 65 percent.

Treat the causes

If you often have trouble sleeping or wake up tired, talk with your doctor about whether one of the conditions described below might be causing the problem.

Sleep apnea. Symptoms of this disorder include frequent, loud snoring. It can cause breathing to stop for 10 seconds or longer throughout the night, disrupting sleep and increasing the risk of high blood pressure, heart disease, mood and memory problems, and driving accidents. Shedding excess pounds can alleviate it in some cases. Avoiding alcohol, smoking and sedating medication can also help, as can sleeping on your side. In moderate and severe cases, the most effective treatment is continuous positive airway pressure, or CPAP, which involves using a mask that blows air into your throat to keep the airways open. Dental appliances that reposition the lower jaw and tongue might help in mild cases.

Restless legs syndrome. The condition, marked by a strong urge to move your legs, worsens in the evening and when you’re lying down, and is often accompanied by leg-jerking before sleep. To manage symptoms, take daily walks and avoid alcohol, caffeine and smoking. Before bedtime, do calf stretches, take a hot bath, massage your legs or do relaxation exercises.

Frequent nighttime urination. This is the No. 1 cause of insomnia among older adults, because aging bodies produce less of a hormone that enables people to retain fluid. But multiple bathroom calls might also signal uncontrolled diabetes, prostate enlargement, sleep apnea or a urinary tract infection, so talk with your doctor. Limit your consumption of liquids two hours before bedtime, especially alcohol, citrus juices and drinks with caffeine or artificial sweeteners.

Heartburn. If you experience a burning sensation in your chest two or more times a week, see your doctor. You might have gastroesophageal reflux disease, or GERD, which can inflame the lining of the esophagus and awaken you at night with heartburn, indigestion, coughing or choking. Minimize symptoms by eating small meals, not lying down for three hours after eating, avoiding fatty, spicy or acidic food, not smoking and losing excess weight.

Osteoarthritis. Cognitive-behavioral therapy improved both insomnia and arthritis pain in older patients in a 2009 study in the Journal of Clinical Sleep Medicine. And gentle yoga practiced about an hour before bedtime relieved sleep disturbance in women with osteoarthritis in a 2011 pilot study in the journal Sleep Medicine. Most important, lose extra weight and try to exercise regularly to reduce arthritis pain.

Nocturnal leg cramps. These painful muscle contractions, often in the calf and sometimes in the thighs or feet, commonly awaken older people. You might find relief by pulling the top of your foot toward your shin while extending your knee, massaging the affected leg or walking.

Hot flashes. More than half of menopausal women report chronic insomnia, primarily because of hot flashes that interrupt sleep and leave them drenched in sweat and shivering. To ease night sweats, lower the bedroom thermostat or use a fan; sleep on cotton sheets and wear cotton nightclothes; take a cool shower before bed; keep ice water at your bedside; and place a frozen ice pack under your pillow, turning the pillow often.

Emotional distress. Treatment for anxiety and depression generally involves psychotherapy aimed at changing thoughts and behavior that feed the problem, often paired with newer antidepressants such as fluoxetine (Prozac and its generic cousins) and sertraline (Zoloft, for example). If those pills worsen your insomnia, ask your doctor about switching the timing or the drug. Regular exercise can help ease both anxiety and depression.