MANAGEMENT OF INSOMNIA

This is achieved using both non-pharmacologic (non-medical) and pharmacologic (medical) approaches.

1) Non-Pharmacologic

Firstly anyone who is a light sleeper or has sleep problems should adopt proper sleep hygiene. Hence one should avoid coffee, tea and drinks containing caffeine from late afternoon onwards, avoid prolonged afternoon naps and ensure that the bedroom is quiet (ear plugs can help) and comfortable. Alcohol should be reduced: although it appears to help induce sleep, it actually disrupts sleep later on. Only go to bed when very sleepy and get out of bed to do some quiet reading if still not asleep after 15 minutes. Relaxing activities such as meditation or practising muscle relaxation before sleep also helps.

2) Pharmacologic

For individuals who need it, the doctor may prescribe sleeping pills. Sleeping pills generally belong to a group of sedatives called benzodiazepines. Certain sedatives such as zolpidem and zopiclone have benzodiazepine-like actions. Different sedatives are effective in promoting sleep in various ways, for example the shorter-acting ones (such as lorazepam) promote initiation of sleep without causing much daytime sedation, whereas the longer-acting ones (such as diazepam) help one to maintain a longer period of uninterrupted sleep. Despite its proven effectiveness, in a small proportion of users, benzodiazepines are associated with dependence (difficulty stopping its use and need for larger doses over time): this risk is much reduced if the users take the pills for short periods, in moderate doses and under medical supervision. As the patient’s condition improves, the doctor will instruct the tapering down of sedative doses. It is important to note that most users of sleeping pills successfully stop its use when their conditions are treated.

Some individuals taking longer acting benzodiazepine sedatives might experience daytime sleepiness and this is of concern when driving or operating machinery. Sometimes, a person with concerns about the addictive potential of benzodiazepine sedatives may instead be prescribed antihistamines (such as certain flu medicines) or antidepressants with sedating properties. These can work equally well.

It is also important to note that in individuals with depression or anxiety, sleeping pills are adjuncts to antidepressants and anti-anxiety medicines, which are main medical treatment. As the individual’s depression lifts, his sleep will also improve.

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Expert Author:

Dr Thong Jiunn Yew, Nobel Psychological Wellness Clinic