What is insomnia?
Symptoms of insomnia
- Difficulty falling asleep
- Waking up too early in the morning
- Waking up often during the night and having difficulty falling back asleep
- Feeling tired after waking up
- Irritability and problems with concentration during daytime
Types of insomnia
- Primary insomnia - problem is not associated with other health complaints (e.g. anxiety)
- Secondary insomnia - problem is associated with a condition, medicine, or ingested food/drink
Causes of insomnia
- Environmental factors - e.g. noise, light, too cold, too hot
- Poor sleep habits
- Irregularities in usual sleep routine
- Alcohol, caffeine, nicotine
Which medicines can cause sleep disturbance?
- Alpha blockers - e.g. tamsulosin
- Beta-blockers - e.g. atenolol
- Corticosteroids - e.g. prednisolone
- SSRIs - e.g. fluoxetine
- Cholinesterase inhibitors - e.g. donepezil
- Side effects and physiological influences of other medicines may also indirectly cause insomnia.
- ACE inhibitors - some patients may develop a dry, tickly cough due to the inhibition of bradykinin degradation.
- Statins - muscle pain is a relatively common side effect of statins
Treatment of insomnia
- Treatment of acute insomnia is often not required
- Modification of lifestyle and dietary factors should be undertaken first if deemed necessary
- Drug treatment should be used for as short a time as possible. Several drug classes are available for treatment of insomnia
- Benzodiazepines - Nitrazepam and flurazepam have a prolonged action and may cause residual effects the following day after waking. Loprazolam and temazepam have a shorter duration of action and usually have no hangover effects the following day. Note: Adverse withdrawal effects are more common with shorter acting benzodiazapines.
- Zopiclone, zolpidem, and zalepon - are not benzodiazepines but act at the benzodiazapine receptor. Note: Not licensed for long-term treatment of insomnia. Also, these drugs are schedule 4 controlled drugs and therefore prescriptions are only valid for 28 days
- Melatonin - licensed for short-term treatment of insomnia in those who are over 55 years old
- Management of secondary insomnia should involve identifying and treating the underlying cause of the insomnia. For example, if anxiety is responsible for sleep disturbance, use of anxiolytics may improve sleep hygiene
Self-help tips to improve sleep hygiene
- Exercise regularly - but do not do so within four hours of bedtime as this can make sleeping more difficult
- Try to maintain regular sleeping routine - do not take naps, set a regular time to wake up
- Only go to bed when you feel tired
- Don't drink caffeinated drinks a few hours before bedtime
- Don't eat just before bed
- Try to remove any factors that may affect sleep e.g. try to relax on a night time by reading, taking a bath etc.
- Make sure that your room is dark, quiet, comfortable and at a suitable temperature