Insomnia: Not worth losing sleep over
Insomnia is defined as having difficulty falling asleep, maintaining sleep or not feeling refreshed after sleep. Sleep disturbance can result in poor social and occupational functioning. It can cause significant distress. Insomnia affects 20-30% of the population.
Insomnia is associated with several medical conditions including:
* Stress, depression, anxiety
* General physical health problems contributing to the sleep problem
* Restless leg syndrome
* Obstructive sleep apnoea
* Certain medication
* Caffeine
* Alcohol
Good sleep hygiene is a really important component of managing insomnia. This involves various behavioural modifications which can be tried before coming to your GP.
These include:
* Wake up at the same time, regardless of when you go to sleep
* Go to bed at the same time every night
* Exercise regularly but not within 4 hours of bedtime
* Maintain a quiet and cool environment
* Avoiding taking naps during the day
* Avoiding caffeine, smoking, and alcohol for about 6 hours before going to bed
* Avoiding using electronic devices before going to bed
* Practice some relaxing activities before bed, hot bath, warm milk, music, light reading
Maintaining a sleep diary can be helpful to identify the pattern of insomnia and any factors which may contribute to it. This involves recording the time you go to bed, the time it takes to fall asleep, how many times you wake during the night, when you wake up, and times of meals and exercise.
Cognitive behavioural therapy can also be beneficial for insomnia. It can help you to develop good sleep habits and can also help you to manage worries which keep you awake. CBT has proven to be as effective as medication.
Medications may be prescribed if your symptoms are severe or if nondrug treatments are not helping. These medications include: benzodiazepines, non-benzodiazepines and melatonin.
Benzodiazepines help reduce anxiety and help with relaxation and sleep. They are highly addictive and can lead to dependency and should not be used long term. Z medicines, which work in a similar way to benzodiazepines and may be used as an alternative to them. Both benzodiazepines and Z medicines can result in adverse cognitive effects (such as memory loss), daytime fatigue, addiction, tolerance, psychomotor effects (such as falls, fractures, road traffic crashes) and excess mortality. You cannot drive or drink alcohol after taking these medications.
Melatonin is a natural hormone that we produce in our body that helps regulate sleep cycles. It is only started under specialist supervision.
There is no quick fix to insomnia and treating this may take months with appropriate adherence to good sleep hygiene and possibly also short term medication. Treatment goals include improved sleep at night as well as improved daytime functioning. If medications are used, they should be tapered off and discontinued accordingly.
