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Mythbuster: ‘Insomnia can only be cured by medication’



Psychiatric liaison nurse Fiona Brand on alternatives to medication for insomnia.

Firstly, it is important to define insomnia. The NHS1 says that if you ‘regularly have problems sleeping’ then that fits with a diagnosis of insomnia.

Insomnia is the inability to fall asleep or stay asleep and can be chronic, where it can last for months, or acute, due to temporary disturbances in life.

A more precise definition of chronic insomnia is defined by the DSM-V as more than three nights a week of disturbed sleep for more than three months.2

The most common reasons for insomnia are illness or stress.

There are multiple consequences to insomnia, predominantly a decrease in productivity in all areas of one’s life, an increase in the risk of accidents, and an increase in the likelihood of a deterioration in both mental and physical health.

It is important to get the treatment for insomnia right. Insomnia is treatable.

The patient may feel that ‘sleeping pills’ are the only solution. However, sleeping tablets or hypnotics are rarely prescribed for insomnia any more. The evidence points strongly towards self-help by making environmental and lifestyle changes, and where necessary, some talking therapy.

To have a healthy sleeping routine without using medicines, you must create a suitable environment. Our body has an internal clock that depends on light, food, and energy levels to go into restful sleep. Patients should try to be in natural light during the day and darkness at night, cut out the noise from TV or other sources, put smartphones or laptops in another room, eat their evening meal two to three hours prior to going to sleep, and avoid caffeine and other stimulants. They should ensure they have had some physical exercise during the day and maintain a consistent routine.

Reassuring the patient that it is normal to suffer from insomnia at some point in their life and that countless others are plagued with sleeplessness can be helpful. However, encouraging patients to change their sleep hygiene and routines can have a significant impact on the difficulties they are experiencing.

Insomnia has multiple implications for daily life and it is important to ascertain the cause of insomnia to assist with rectifying the problem. By enquiring if there is any recent or ongoing stress that may be contributing towards the insomnia can prompt the patient to think about any events or difficulties that they may not have considered could be causing their problems.

Cognitive behavioral therapy for insomnia (CBT-I) has long been shown to be more efficacious than other pharmacological treatments.3 There is lots of evidence to show that CBT-I, alongside environmental and behavioral changes, can have a long-lasting positive impact on insomnia.

References

  1. National Health Service Guidelines on Insomnia. www.nhs.uk/conditions/insomnia/
  2. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Insomnia Disorder Comparison (2013) American Psychiatric Association.
  3. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioural Therapy: A Review of Meta-analyses. Cognitive therapy and research, 36(5), 427–440. doi:10.1007/s10608-012-9476-1