Cognitive and behavioural treatments

Cognitive behavioural therapy (CBT) aims to change unhelpful thoughts and behaviours that may be contributing to your insomnia. CBT is usually recommended if you've had sleep problems for more than four weeks. It includes :

STIMULUS-CONTROL THERAPY :

It aims to help you associate the bedroom with sleep and establish a consistent sleep/wake pattern.

SLEEP RESTRICTION THERAPY :

You limit the amount of time spent in bed to the actual amount of time spent asleep, creating mild sleep deprivation; sleep time is then increased as your sleeping improves.

RELAXATION TRAINING :

This aims to reduce tension or minimise intrusive thoughts that may be interfering with sleep

PARADOXICAL INTENTION :

You try to stay awake and avoid any intention of falling asleep; it's only used if you have trouble getting to sleep, but not maintaining sleep.

BIOFEEDBACK :

Sensors connected to a machine are placed on your body to measure your body's responses, such as muscle tension and heart rate; the machine produces pictures or sounds to help you control your breathing and body responses Sometimes, CBT is carried out by a specially trained GP. Alternatively, you may be referred to a clinical psychologist.

Sleeping tablets

Sleeping tablets (hypnotics) are medications that encourage sleep. They may be considered:

• If your symptoms are particularly severe
  
• To help ease short-term insomnia
• If the non-drug treatments that are mentioned above fail to have an effect

However, doctors are usually reluctant to prescribe sleeping tablets as they relieve symptoms but don't treat the cause of your insomnia. If you have long-term insomnia, sleeping tablets are unlikely to help. Your doctor may consider referring you to a clinical psychologist to discuss other approaches to treatment.

Benzodiazepines

Benzodiazepines are tranquillisers that are designed to reduce anxiety and promote calmness, relaxation and sleep. These medicines should only be considered if your insomnia is severe or causing you extreme distress. All benzodiazepines make you feel sleepy and can lead to a dependency.

Z medicines

Z medicines are a newer type of sleeping tablet that work in a similar way to benzodiazepines. There's little difference between the benzodiazepines and Z medicines. If one doesn't work, then swapping to another is unlikely to have a different effect.

Melatonin (Circadin)

Medicines that contain melatonin have been shown to be effective in relieving insomnia for up to 26 weeks in elderly people. Melatonin is a naturally occurring hormone that helps regulate the sleep cycle (known as the circadian rhythm). At present, Circadin is the only medicine that contains melatonin. It's licensed to treat insomnia. Circadin is only available on prescription for people who are 55 years old or over. Circadin is designed as a short-term treatment for insomnia and shouldn't be taken for more than three weeks. It's not recommended for people with a history of kidney disease or liver disease. As yet, there's not enough evidence to say whether it's safe to take Circadin during pregnancy or while breastfeeding, so its use isn't recommended under these circumstances.

Sleep Hygiene Rules

• Never use the bedroom for anything but sleep or relaxation. Read, watch TV, exercise, eat or argue someplace else.
• Lie down intending to go to sleep only when you are sleepy.
• If you are unable to fall asleep within twenty five minutes, get up and go to another room. Stay up until you feel sleepy then return to bed. If you still are unable to fall asleep get up again.
• Set your alarm to get up at the same time each day regardless of how much sleep you got during the night.
• Turn on the lights or walk outside in the sunlight when you wake up in the morning.
• Do not nap during the day.
• Exercising in the morning or late afternoon will help you sleep, but exercising in the late evening will stimulate your body and make sleeping more difficult.
• Eat your evening meals at least two hours prior to going to bed. Large meals or hunger can inhibit sleep.
• Avoid caffeine and refined sugars in the evening. Foods like chocolate, coffee, tea and soda will inhibit sleep. Also tobacco and alcohol should be avoided since these disrupt sleep.
• Avoid the use of over the counter sleep medicines.
• Relax in the evening before going to bed. Try not to rehash the day's problems.