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Insomnia

Insomnia

Insomnia refers to the disruption of normal sleep patterns. It can relate to difficulty trying to get to sleep, or waking in the middle of the night and being unable to fall back to sleep. For others it’s a case of waking too early and feeling completely unrested. For sufferers, lying awake at night while craving sleep can feel torturous and impact on how the person feels and functions during the daytime. It’s thought about a third of people in the UK have bouts of insomnia - which amounts to an awful lot of people counting sheep.

Symptoms:

  • Difficulty falling asleep.
  • Waking during the night.
  • Waking too early.
  • Waking feeling unrefreshed.

What causes insomnia?

Sleep disturbance can be caused by physical or psychological factors. Stress is a common cause with many people lying awake at night worrying about issues such as finances, work and relationships. Insomnia is also common in people who are depressed or suffering from anxiety.

Many medical conditions - ranging from heart disease to arthritis - can also lead to poor sleep, plus there are some specific sleep disorders such as sleep apnoea which disrupt normal sleeping patterns.

Insomnia can also be a side-effect of some medication.

How is insomnia treated?

Cognitive and behavioural treatments may be offered by specially trained GPs or clinical psychologists. Treatments include:

  • Stimulus-control therapy which aims to help you associate the bedroom with sleep and establish a consistent sleep/wake pattern.
  • Sleep restriction therapy where 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 to reduce tension or intrusive thoughts that interfere with sleep.
  • Paradoxical intention, which means you try to stay awake - sometimes used if you have trouble getting to sleep, but not maintaining sleep.
  • Biofeedback, where sensors are placed on your body to measure responses like muscle tension or heart rate. The machine then produces pictures or sounds to help you control your breathing and body responses.
  • Cognitive behavioural therapy (CBT), where you are taught to examine and change your beliefs and attitudes about insomnia.
  • Medication can also be used to treat insomnia - namely sleeping tablets (hypnotics). These are usually only used if non-drug treatments have failed, or if symptoms are particularly severe or to ease short-term insomnia. *Experts recommend that these drugs are only used for short courses or acutely distressed patients.
  • Sleeping pills relieve symptoms but do not treat the causes of insomnia. It is also easy to become dependent on these medicines. Short-acting benzodiazepines or the newer 'Z medicines' (see below) are the preferred medicines for insomnia and are only available on prescription.
  • Benzodiazepines are tranquillisers designed to reduce anxiety and promote calmness, relaxation and sleep. Short-acting benzodiazepines that may get prescribed include: Temazepam, Loprazolam and Lormetazepam.
  • Z medicines are a newer type of sleeping tablet that work in a similar way to benzodiazepines. They are also short-acting and include: Zopiclone, Zolpidem and Zaleplon.
  • Medicines containing melatonin can provide short-term relief for insomnia. Melatonin is a naturally occurring hormone that helps regulate the sleep cycle (known as the circadian rhythm). Levels of melatonin increase at night promoting the desire to sleep. At present, the only licensed medicine for the treatment of insomnia that contains melatonin is ‘Circadin’, available on prescription for people aged 55 or over.

Alternative remedies & self-help:

  • Make sleeping and waking routine by going to bed and rising at the same time each day. Do not catnap during the day and exercise around four hours before you plan to go to bed (which gives you body time to cool down).
  • Stop drinking coffee or tea four hours before bedtime and avoid alcohol and smoking (which act as stimulants). Avoid heavy meals just prior to bed.
  • Snacks containing ‘tryptophan‘ (a natural sleep-promoting amino acid) can help promote sleep - sources include bananas and fish. A warm milky drink may also help.
  • Use thick blinds or wear an eye mask if the morning light wakes you too early. Wear ear plugs to block out noise and ensure your bed and covers are comfortable.
  • Only use your room for sleeping or sex. Do not watch TV, make phone-calls or eat or work in there.
  • If you find you are still awake 30 minutes after trying to go to sleep. Get up for a short period rather than lying in bed getting distressed. Then try again a bit later.
  • Write your worries and solutions on a list prior to getting into bed and then forget them until the morning.
  • Some people use alternative methods such as hypnotherapy and acupuncture to treat insomnia.
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