(I) Pyschological therapies
Psychologists can teach simple relaxation techniques. They can also provide “talking therapy” (psychotherapy) which can help people come to terms with various life events – e.g. bereavement, marital problems etc. that may be triggers of insomnia. Psychological “tricks” can also be taught – e.g. telling you to try and keep awake, which often has the opposite effect.
Specific sleep therapy includes cognitive behaviour therapy (CBT) which deals with misconceptions about sleep such as believing that frequent short naps during the day are good for you.
If work or leisure activities are disturbed by daytime sleepiness, or if you wake up feeling unrefreshed and irritable, you should consult your GP. Some doctors feel that prescription-only medication –known as hypnotics – should be started as soon as these problems start, while others believe that sleep hygiene methods should be tried first. In all cases, drugs should be used for as short a period as possible, and certainly no longer than two weeks. Beyond this, there’s a danger that dependency (addiction) to sleeping tablets, will develop. A GP will also be able to detect any underlying cause of insomnia that also needs treatment. Depression, for example, may need treatment with antidepressants as well as sleeping medication. The GP may prescribe the following drugs:
- Nitrazepam useful and effective but can be habit forming in long term. It continues to work for several hours (medium-acting) which means it has the potential to cause hangover drowsiness the following morning.
- Temazepam and lormetazepam are shorter acting, and less likely to cause daytime drowsiness.
All benzodiazepines can affect hand-eye co-ordination, which can impair driving ability and operating machinery the next day. Because of their potential for causing dependence, doctors are now discouraged from prescribing benzodiazepines for insomnia except for very short term use in specific situations, such as in people who are very distressed.
Newer drugs – zopiclone (zimovane), zolpidem (stilnoct), zaleplon (sonata)– are very short acting. In theory they should cause less daytime drowsiness than the benzodiazepines and have less potential for causing dependence, but there are few scientific studies comparing the two groups. Zopiclone can cause a metallic taste in the mouth. Other side-effects affecting these drugs include indigestion and headache.
Antidepressants – if a person with insomnia has depression, some ‘tricyclic’ antidepressant medicines –such as dothiepin and trazodone – also have a sedative effect. These drugs do not cause dependence.