Insomnia

Treatment will depend on the cause of the insomnia. A combination of behavioural approaches and medications are usually offered.

Nearly everyone can benefit from an improved sleep hygiene. People with sleep disorders should work with their doctors to diagnose the problem and treat conditions that may be responsible.

If your doctor diagnoses primary insomnia, consider behavioural therapy first, then discuss the proper use of prescription sleeping pills.

Good Sleep Hygiene

These simple tips can help you get a good night’s sleep:

1.Do not go to bed unless you are sleepy.

If you are not sleepy at bedtime, then do something else. Read a book, listen to soft music or browse through a magazine. Find something relaxing but not stimulating to take your mind off of worries about sleep. This will relax your body and distract your mind.

2.Use your bed only for sleeping and sex and never for reading or watching TV.

If you are not asleep after 15 - 20 minutes, get out of bed. Find something else to do that will make you feel relaxed.

If you can, do this in another room. Read quietly with a dim light, but do not watch the TV since the fullspectrum light emitted by the TV has an arousing effect.

Similarly, using your phone just before your bedtime is not recommended due to the arousing effect from the light emitted. When you feel sleepy, get back into bed.

3. Do not nap during the day unless it is absolutely necessary.

Even then, restrict your nap to 15 - 20 minutes in the early afternoon.

4. Begin rituals that help you to relax each night before bed.

Establish a regular bedtime and a relaxing bedtime routine, such as taking a warm bath or listening to soothing music.

Whenever possible, wind down late in the day, such as by scheduling stressful or demanding tasks early, and the less challenging activities at a later time.

5. Get up at the same time every morning.

Do this even on weekends and on holidays.

6. Eat properly and practise healthy habits.

• Do not go to bed hungry, but do not eat a big meal near bedtime either.
• Avoid caffeine, especially after mid-afternoon.
• Avoid alcohol after dinner time; although many people think of it as a sedative, alcohol can actually impair the quality of your sleep.
• Try to avoid all beverages after dinner if you find yourself getting up at night to urinate.
• Do not have a cigarette or any other source of nicotine before bedtime.
• Get plenty of exercise early in the day. Avoid any tough exercise within three hours of your bedtime.

7. Make your bedroom quiet, dark and a little bit cool.

Your bedroom should be wellventilated and kept at a constant, comfortable temperature.

Try using a sleep mask or ear plugs to compensate for any problems in your sleeping environment.

8. Above all, do not worry about sleep.

Watching the clock never helps. Except when keeping a sleep diary, do not keep track of the amount of time you spend trying to sleep. Instead, rest quietly and peacefully.

Try not to lie in bed reviewing your problems and plans. If you are overloaded, get out of bed and make a list. Then return to bed and think of something relaxing and pleasant.

Common (Psychological) Behavioural Approaches

Relaxation therapy

Relaxing your mind at bedtime will help you drift off to sleep. It takes much practice to learn the techniques and to achieve effective relaxation.

Stimulus control therapy

Go to bed only when you are sleepy. Do not read, watch the TV or snack in bed. Get up at the same time every day, no matter how little sleep you have had.

Avoid daytime napping. This technique helps to recondition you such that you associate the bed and bedtime, with sleep only.

Sleep restriction therapy

Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. If this is the case for you, reduce your time in bed to the estimated total time you sleep in an average night (minimum five hours) by going to bed at a later time.

Get up at the same time every day. Maintain the same bedtime every night for a week, and then move it 15 minutes earlier every week until you get a satisfying, relaxing amount of sleep. Then maintain the same schedule every day.

Cognitive therapy

Learn to replace negative thoughts about sleep (‘I will never get to sleep tonight’, ‘I will not be able to function tomorrow’, or ‘I will fall sick unless I sleep eight hours a night’) with positive thoughts (‘If I relax peacefully in bed, my body will take care of itself’).

Medication for insomnia

People have used sleeping tablets for many years, but we now know that:

• They do not work for very long.
• They leave you tired and irritable the next day.
• They lose their effect quite quickly, so you have to take more and more to get the same effect.
• Some people become addicted to them. The longer you take sleeping tablets, the more likely you are to become physically or psychologically dependent on them.
• There are some newer sleeping tablets (Zolpidem and Zopiclone), but these seem to have many of the same drawbacks as the older drugs, such as Valium and Ativan.

Sleeping tablets should only be used for short periods (less than two weeks) - for instance, if you are so distressed that you cannot sleep at all.

If you have been on sleeping tablets for a long time, it is best to slowly cut down the dose after discussing it with your doctor. In some cases, antidepressant tablets may be helpful.

Over-the-counter medications are not usually recommended, for the treatment of insomnia.