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Over 5 million prescriptions for sleep medication was prescribed in England in 2022/23. With many classed as 'dependency forming', Dr Xand joined us to give us his tips for a good night's sleep without the use of pills

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DIFFERENT TYPES OF INSOMNIA

Short Term ('Acute') Insomnia

This is a brief episode of difficulty sleeping which lasts for less than three months. It can be caused by a stressful life event, such as the loss of a loved one, a disconcerting medical diagnosis or a major job or relationship change. Short term insomnia is more common in women than in men, and it can arise during pregnancy as well as menopause.

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Chronic Insomnia

Chronic insomnia is different, this is where people struggle to get to sleep at least three times a week and have been for at least 3 months. Naturally, this type of insomnia is much more serious and can adversely your health, and quality of life as well as decrease your productivity at work. It can also cause irritability during the day and increase the risk of things like motoring accidents. In fact, research has shown that insomniacs are up to 4.5 times more likely than to have an accident than people who don't have the condition. Chronic Insomnia is also considered a contributing risk factor for medical problems like cardiovascular diseases, chronic pain syndrome, depression, anxiety, diabetes, obesity, and asthma and it commonly coexists with other psychiatric and medical conditions, for example anxiety, depression and breathing disorders (COPD)

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USING SLEEP MEDICATION FOR INSOMNIA

Although technically over the counter and prescription medication can help you fall asleep, they remain problematic due to side effects and the concern that you could become dependent on them. For people with acute insomnia, many over the counter medicines and prescription medication can cause something called 'rebound insomnia'. This occurs when a person stops taking a medication that usually helps them sleep. Sometimes, rebound insomnia is worse than the insomnia a person experienced before treatment. For those experiencing chronic insomnia, sleeping tablets aren't going to solve the problem, therefore current guidelines for GPs don't recommend prescribing them for this type of condition at all, as the risk of dependence (or addiction) increases with the duration of treatment.
In the first instance, sleep disorders (such as obstructive sleep apnoea or breathing problems) should be considered when assessing a person with suspected insomnia, and in others, cognitive behavioural therapy is recommended to try and address the underlying problem. Unlike medication, benefits associated with behavioural therapy continue to have a positive effect after completion of treatment.

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WHAT CAN PEOPLE TRY INSTEAD OF USING SLEEP MEDICATION?

Research suggests that those who do high-intensity exercise less than an hour before trying to sleep take longer to drift off and have poorer sleep quality, so exercising earlier in the day can have its benefits.

People who are also in the routine of eating a big meal before bed may find they struggle to get to sleep too. In this area, experts recommended eating up to two hours before bedtime to avoid negative effects. In contrast, there's research to show that eating meals high in carbohydrates at least four hours before bedtime can improve how quickly we fall asleep. This is because the carbohydrates help the body to produce insulin which in turn helps to produce hormones tied to sleep and feelings of well-being. As well as this, there's been some research done on minerals contained in some foods that may be a benefit such as magnesium which is found in green leafy vegetables, such as spinach, legumes, nuts, seeds, and whole grains. There's some evidence to show that magnesium in particular has an antidepressant effect and may increase production of those sleep hormones while reducing stress hormone levels too.

For people who are kept awake because of anxiety or racing or repetitive thoughts, cognitive behavioural therapy might be a good option. This involves examining your thoughts, feelings and behaviour patterns, and working out ways to remove yourself from these negative cycles. It mainly focuses on present concerns but certain CBT approaches can also address earlier traumatic memories that may contribute to your lack of sleep.
CBT-I is available on the NHS and it usually consists of a number of sessions containing different things.
You might be asked to keep a sleep diary, there are sessions that might help you to manage the worry and frustrations associated with being awake in bed during the night. Other sessions might address your sleep hygiene including your daytime and night time routines and behaviours as well as your sleep environment.
You might also be taught distraction techniques that you can use if you are in bed and are awake, to stop you from having lots of intrusive thoughts.
It's a really effective way of addressing the underlying problem related to sleep, so if you think you could benefit from CBT-I, consider visiting your GP and see what options are available.

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Other Tips For Sleep

• Be consistent. Go to bed and get up at the same time each night and morning, including at weekends
• Make sure your bedroom is quiet, dark and at a comfortable temperature
• Remove electronic devices, such as TVs, laptops and smart phones from the bedroom and avoid using them before going to sleep
• Steer clear of caffeine and alcohol before bedtime

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USEFUL LINKS

• More information on Insomnia is available from the NHS
• More information on CBT (Cognitive Behavioural Therapy), including where to access services is available
• Further help on tackling sleep problems can be found