In this 10 minute clinic episode we look at insomnia and its assessment, what causes it and ways of treating it. We also discuss simple tips you can do at home that can cure one in three cases of insomnia without the need for any medication.
Take-home points
- There is no standard definition of what is a normal sleep requirement. This varies with ageing, and from person to person
- With increasing age, total sleep time decreases
- The normal time taken to fall asleep is considered to usually be less than 30 minutes
- Insomnia is a ‘24 hour disorder’ as it impairs daytime well-being and subjective abilities and functioning
- Probably best described as a condition of ‘Unsatisfactory sleep, either in terms of sleep onset, sleep maintenance or early waking
- It is believed to affect around a third of the general population in the UK and is between 1.5 and 2 times higher in women
- Insomniacs are often fatigued/anxious and become more tense and worried as bedtime approaches
- When assessing insomnia, take a careful history to establish a possible underlying cause. What does the patient mean by ‘not sleeping’? Examine for possible cause including bloods – TFTs/Fe/HbA1c and always advise to keep a sleep diary for at least 2 weeks. If OSA possible consider an overnight sleep study (polysomnography). Don’t rush to Rx – give sleep hygiene advice first
- About one third of patients with primary insomnia will improve with sleep hygiene advice alone
- Treatment is only appropriate when insomnia causes significant personal distress or marked impairment
- Hypnotics should be limited to the lowest effective dose for the shortest time possible, with a maximum four-week treatment period and avoided where possible in the elderly.
- Prolonged-release melatonin can improve sleep onset and quality in patients aged over 55 with persistent insomnia.
References and resources:
- Scenario: Managing short-term insomnia (< 3 months) | Management | Insomnia | CKS | NICE
- Scenario: Managing long-term insomnia (> 3 months) | Management | Insomnia | CKS | NICE
- Insomnia – Symptoms, diagnosis and treatment | BMJ Best Practice
- B175. Hypnotics 2.0 (prescqipp.info)
- How to sleep better | Mental Health Foundation
- Insomnia – NHS (www.nhs.uk)
