What Are The Treatments For Insomnia
Treatments include lifestyle changes, counseling, and medicines:
- Lifestyle changes, including good sleep habits, often help relieve acute insomnia. These changes might make it easier for you to fall asleep and stay asleep.
- A type of counseling called cognitive-behavioral therapy can help relieve the anxiety linked to chronic insomnia
- Several medicines also can help relieve your insomnia and allow you to re-establish a regular sleep schedule
If your insomnia is the symptom or side effect of another problem, it’s important to treat that problem .
NIH: National Heart, Lung, and Blood Institute
Opportunities For Insomnia Intervention
Inconsistent approaches to diagnosis and lack of awareness often lead to insomnia remaining undiagnosed. This is in part owing to a lack of education for both the general population and healthcare professionals around sleep and sleep disorders, highlighting an important role for pharmacists in the identification and consequent treatment of patients with insomnia in community, general practice and hospital settings.
Many patients purchase over-the-counter medicines â or collect their prescribed medicines relating to sleep â from community pharmacies, providing an opportunity for pharmacists to engage patients in discussions regarding healthy sleep behaviours. Pharmacists working in general practices may spot a potential undiagnosed case of insomnia â during chronic disease management or medication review consultations â for referral to colleagues in general practice for further investigations and formal diagnosis.
Pharmacists who lack confidence in this area may build their confidence by following up with patients to identify outcomes â for example, by placing a note on the patientâs records to speak to the patient to see how they responded to proposed treatments, or speaking to another healthcare professional looking after the patient to monitor progression and management. Although finding time to do this may be challenging, following up on recommendations will help develop practice.
Managing Expectations Of Normal Sleep
Even in healthy adults, the need for sleep decreases as age increases, with the time spent asleep and the structure of this sleep, or âsleep architectureâ, changing. As sleep latency increases, more time is spent in stages 1 and 2 of non-rapid eye movement sleep and less time is spent in rapid eye movement sleep stages.
Managing patient expectations around normal sleep length and quality through ageing is important. For example, no matter the measures taken, it is unlikely that an individual aged over 65 years will be able to routinely sleep like an adolescent again. Consequently, it is possible that in advanced age, those requiring less sleep are unnecessarily prescribed medicines to aid sleep to try to reach unrealistic sleep targets, leading to over-sedation and potentially increasing the risk of falls. In addition, cognitive impairment as a side effect of hypnotics can also lead to false dementia diagnoses. Comorbidity and polypharmacy is more common in advanced age, and the impact of additional disease states and medicines can further disturb sleep.
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Protecting People From Poor Sleep
Many causes of sleep disruption are preventable; therefore, issues with sleep can be prevented before insomnia occurs. Poor sleep can be improved by modifying factors, such as stress, excitement, anticipation, pain, illness, changes in sleep schedule, daytime napping, change of time zone or altitude, medicine, noise and light.
There are three simple steps every pharmacist can take to understand and protect a patientâs sleep:
Although patient-directed information about this may be limited, the examples below outline the effect of lifestyle and medicines on sleep, and highlight important changes that should be made:
Journal Of Insomnia And Sleep Disorders
Journal of Insomnia and Sleep Disorders is an open access, peer-review Journal publishing original research & review articles in all fields of sleep disorders. The journal provides a pathway for researchers, scientists, scholars and academicians publish and find recent advances and updates in treatment of sleep disorders.
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What Are The Types Of Insomnia
Insomnia can be acute or chronic . Acute insomnia is common. Common causes include stress at work, family pressures, or a traumatic event. It usually lasts for days or weeks.
Chronic insomnia lasts for a month or longer. Most cases of chronic insomnia are secondary. This means they are the symptom or side effect of some other problem, such as certain medical conditions, medicines, and other sleep disorders. Substances such as caffeine, tobacco, and alcohol can also be a cause.
Sometimes chronic insomnia is the primary problem. This means that it is not caused by something else. Its cause is not well understood, but long-lasting stress, emotional upset, travel and shift work can be factors. Primary insomnia usually lasts more than one month.
Writing Off Sleep Problems
Studies have shown that people who have trouble sleeping are prone to fretting and worrying at bedtime. These unwelcome thoughts produce stress and , which make people feel keyed up when they want to wind down. Ordering the thoughts to stopand getting mad when that doesnt workonly makes the problem worse.
Gently steering your thoughts in a happier direction seems to be more effective. Journaling about positive experiences helps redirect your mind to the good things in your life. Committing your thoughts to paper may have a greater impact than simply thinking them in your head because writing requires a deeper level of psychological processing.
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Spielmans Model Of Insomnia
Factors including age, disease state and lifestyle can predispose people to insomnia. Spielmanâs model is useful when interpreting insomnia. It considers precipitating factors, such as a bereavement or exacerbation of a disease state, that can trigger insomnia and how perpetuating insomnia continues long-term once the original precipitating factor has been resolved. This type of insomnia is difficult to treat as its perpetuating nature can be a result of cognitive and behavioural factors, rather than external causes and as a result may require a level of cognitive restructuring, likely through CBT-I
This model can be used to:
- Take steps to reduce factors predisposing patients to insomnia;
- Discern between disease states which are not insomnia, but may precipitate it ;
- Identify perpetuating insomnia, which tends to be largely psychological in nature and caused by behaviours developed in response to the original precipitating insomnia.
Journal Of Sleep Research
Dear readers of the Journal of Sleep Research,
This virtual issue of JSR brings together ten articles published in 2019 and 2020 dealing with different aspects of insomnia.
Insomnia, especially in its chronic form, is a frequent sleep disorder, probably the most frequent sleep disorder of all, afflicting approximately 10% of the adult population worldwide. According to most recent diagnostic criteria, like the DSM-5 or the ICSD-3, we nowadays talk of insomnia disorder instead of primary or secondary insomnia, as it was usually called in ;older versions of ;diagnostic manuals. Insomnia disorder as a diagnostic category encompasses disturbances of sleep, like problems to fall asleep or to maintain sleep and associated daytime sequelae like impairment of concentration or attention, increased fatigue, dysphoria etc. Chronic insomnia significantly increases the risk of developing somatic or mental illness, especially depressive disorders. It has been speculated that the early and adequate treatment of insomnia may be very helpful in avoiding these long-time consequences, and in cases of comorbidity, insomnia treatment may also have a positive impact on the somatic or mental comorbidity. Insomnia comes at a high cost because recent research has shown that insomnia has severe consequences for work productivity, sick leave and many other areas. Summarising, the costs for the society are high, but adequate insomnia treatment is supposed to reduce these.
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What Other Problems Can Insomnia Cause
Insomnia can cause daytime sleepiness and a lack of energy. It also can make you feel anxious, depressed, or irritable. You may have trouble focusing on tasks, paying attention, learning, and remembering. Insomnia also can cause other serious problems. For example, it could make you may feel drowsy while driving. This could cause you get into a car accident.
How Is Insomnia Diagnosed
To diagnose insomnia, your health care provider
- Takes your medical history
- Asks for your sleep history. Your provider will ask you for details about your sleep habits.
- Does a physical exam, to rule out other medical problems that might cause insomnia
- May recommend a sleep study. A sleep study measures how well you sleep and how your body responds to sleep problems.
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Who Is At Risk For Insomnia
Insomnia is common. It affects women more often than men. You can get it at any age, but older adults are more likely to have it. You are also at higher risk of insomnia if you
- Have a lot of stress
- Are depressed or have other emotional distress, such as divorce or death of a spouse
- Have a lower income
- Have an inactive lifestyle
- Are African American; research shows that African Americans take longer to fall asleep, don’t sleep as well, and have more sleep-related breathing problems than whites.
Journaling For Better Sleep
In one study, 41 college students plagued by bedtime worries were randomly assigned to self-help strategies. One group was asked to journal every night for a week. The study found journaling reduced bedtime worry and stress, increased sleep time, and improved sleep quality.
To try the technique used in the study, set aside 15 minutes each night for writing about a recent positive experience. Write about not only what happened, but also how you felt at the time. Forget what your high school English teacher would say about the grammar, punctuation and spelling; the journal is for your eyes only.
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A Journal Of Insomnia
A Journal of Insomnia is a 2013 web documentary about insomnia, produced by Hugues Sweeney and created by Bruno Choiniere, Philippe Lambert, Thibaut Duverneix and Guillaume Braun for the National Film Board of Canada . The production had its premiere on April 18, 2013, as part of the Tribeca Film Festival‘s first Storyscapes section for transmedia.
Site users must register online for an appointment, after which they receive a phone call informing them that they’ve been emailed a link to enter site. Once inside A Journal of Insomnia, users can follow the stories of one of four protagonists who share their own experiences with sleeplessness as well as access close to 2000 contributions from other insomniacs that have been collected since the fall of 2012.
It was nominated for the Sheffield Innovation Award at the 2013 Sheffield Doc/Fest.
Box : Questions To Help Reveal A Patients Sleep History
- How often do you find it difficult to get to sleep or stay asleep?
- Does this occur most nights?
- How does this affect your daytime activities?
- Consider if their answer fits the diagnostic criteria of insomnia or if another sleep disorder is possible.
Scales and indexes for insomnia
Figure 3: Algorithm to determine diagnosis of insomnia
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A Journal Of Insomnia Is A Surreal Interactive Documentary Experience
Imagine this: an appointment at 3:14am. A phone call at 3:12am from Quebec announces the appointment minutes before it happens. Logging onto the A Journal of Insomnia website, white digital artifacts arrange themselves on screen, gradually shaping themselves into an approximation of a mouth. An accented, ethereal digital voice intones, At night I can’t sleep. In developed countries, 30 percent of people are insomniacs like me. Since the fall of 2012, privately under the cover of darkness, I have been meeting them and collecting their stories. Welcome to A Journal of Insomnia. Only by making an appointment and coming back tonight will you receive the full experience. It’s your turn now to invest part of your night. The disembodied voice is followed by a ticking clock and ambient sound collage, which is at once dreamy, disconcerting and beautiful. The whole effect is made all the more surreal in those early interactive moments as the user is drawn toward the computer screen like Max Renn in David Cronenberg’s Videodrome.
All images courtesy of The NFB.
Insomnia Disorder: Diagnosis And Prevention
Insomnia can have a profound impact on a patient; understanding its causes and how it can be prevented can have significant implications on their wellbeing.
- CPD module
- After reading this article, test your knowledge by completing the CPD questions and receive a certificate as a record of your learning.
Broadly defined as a difficulty initiating or maintaining sleep, insomnia disorder , is an often neglected diagnosis. This may be owing to its high subjectivity, its perception as a condition of low importance or even that it is not a medical condition at all,,,. At least one in three people will experience insomnia that can cause sleeplessness or waking without feeling refreshed, during their lifetime. This ultimately impairs daytime function causing tiredness, impaired concentration and mood disturbance,,.
Sleep affects all body systems and deleterious effects to the immune, cardiovascular, endocrine and neuronal systems are seen when sleep deprivation occurs. Sleep deprivation has been shown to impair cognitive and motor function to the same level as alcohol intoxication â Cappuccio et al. showed that injury-involved car accidents were six times more likely to happen in drivers who had less than six hoursâ sleep the previous night,.
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