7Īdverse effects associated with benzodiazepine use include drowsiness and light headedness the next day, psychomotorĪlthough benzodiazepines are effective, their potential for tolerance and dependence limit their use to short-term insomnia. Prolonged action and may cause residual effects the following day. Longer acting benzodiazepines, such as diazepam and nitrazepam, are not usually recommended because they have a more Short acting benzodiazepines, such as temazepam,Īre more suitable for the treatment of insomnia because they act for a shorter time, have no active metabolites and little System, decreasing time taken to fall asleep and increasing sleep duration. When drug treatment is required short-acting benzodiazepines or zopiclone are recommendedīenzodiazepines potentiate the inhibitory effects of gamma-aminobutyric acid (GABA) throughout the central nervous AntihistaminesĪnd antidepressants are less suitable for insomnia. Short acting benzodiazepines and zopiclone are the drugs of choice when pharmacological therapies are required. With a history of chronic insomnia because the risks of long term use are high.
Of insomnia that is likely to persist (e.g. Caution is required for someone who has a brief history It may be appropriate to prescribe a short course of hypnotics for someone with a brief history of insomnia that isĮxpected to resolve quickly (e.g. In the short term there is limited evidence of its effect long term and significant concern exists about dependence, toleranceĪnd difficulty withdrawing people after long term continuous use.Ĭoncomitant use of hypnotics with behaviour therapy may reduce the efficacy of the behaviour therapy. When other approaches prove inadequate, prescription drug therapy may be required. May be suitable for people with tension and anxiety. Stimulus control for those who have engaged in sleep incompatible activities and relaxation techniques In clinical practice, these methods can be initiated according to the most important perpetuating factors for insomnia.įor example, sleep restriction may be more suitable for those patients who have adapted to insomnia by spending excessiveĪmounts of time in bed. Education to alter false beliefs and attitudes about sleep.Tensing and relaxing different muscle groups, meditation, hypnosis, biofeedback or imagery.Increase time in bed by 15 minutes every week when ratio of time asleep to time in bed is at least 90 percent.Reduce time in bed to estimated total sleep time determined by a sleep diary (minimum five hours).Minimise evening fluid intake, leave the bedroom if unable to fall asleep within 20 minutes, limit use of the bedroom.
Avoid bright lights (including television), noise and temperature extremes, large meals, caffeine, tobacco and.1,3 This may include a sleepĭiary, laboratory testing or referral to a sleep clinic, depending on the suspected underlying cause.īox 2: Types of non-pharmacological interventions Respond to initial treatment or if a co-morbid condition is present or suspected.
A more comprehensive evaluation may be required in patients who fail to If initial evaluation of insomnia identifies an acute stressor such as grief or disruption of the sleep environmentīy noise, no further evaluation may be needed. amphetamines, "ecstasy", BZP, drug withdrawal states. Thyroid hormones, sympathomimetics (agitation), diuretics (nocturia), corticosteroids (agitation) and beta-blockers Medications - Appetite suppressants, chronic benzodiazepine use, some antidepressants (mostly SSRIs), hypnotics, antidepressants.Īlcohol - may help initiate sleep but reduces quality and causes early wakening.Ĭaffeine - especially in the evening e.g. DrugsĬeasing medication - rebound insomnia e.g. Urinary frequency - UTIs or prostatic problems.Įndocrine disorders - Hyperthyroidism (sweats), diabetes mellitus (nocturia), diabetes insipidus (nocturia). Painful conditions - Arthritis or headaches. Respiratory disorders - Obstructive sleep apnoea, dyspnoea and coughing. Movement disorders - Restless legs syndrome or periodic leg movements. Loss, crisis, worry, anxiety, depression, dementia, other mental health issues such as hypomania or psychotic disorders. 1 Box 1 lists some common causes of insomnia. Other factors such as underlying health issues, poor sleep environment, shift work or use of medications or other substances Only about 15 to 20 percent of patients with insomnia have no other associated diagnosis. Many conditions can present with symptoms of insomnia
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