As a doctor I frequently consult over this very common but distressing complaint.
Some people are plagued by poor sleep for their entire lives, others seek advice when their sleep suffers following an event which has left their emotional or mental health in turmoil. Depression can have a huge impact on sleep itself, worsening symptoms as poor sleep renders people less able to function. By the time most people visit their doctor they are desperate for anything that will give them an uninterrupted good nights sleep.
Some patients are keen to try prescribed medication such as zopiclone or benzodiazepines such as temazepam. These can be used, but we very much use these as a very short term, last resort due to their addictive nature and concerns over safety. I am also asked about herbal remedies or over the counter medication. There is actually minimal published evidence to suggest they actually work although I have had some individuals report a benefit and in certain circumstances may be worth trying.
Good Sleeping Habits
The safest way to get back to sleeping well is to establish good sleeping habits. A bad nights sleep can cause the temptation of sleeping in the following morning or napping in the day. When bed-time comes around the following night it is then very difficult to sleep, the patient becomes anxious about not sleeping and then the cycle persists. Here are some practical tips.
1) It is important to stick to a fixed bed time and wake up time regardless of how much sleep you have had.
2) No matter how tired avoid napping during the day.
3) Invest some time in making the bedroom a place to relax in, making it clean, tidy and fresh smelling. Avoid making the room to hot, cold, noisy or bright.
4) Avoid coffee, fizzy drinks or energy drinks, alcohol and drugs including nicotine altogether. Opting for relaxing herbal teas like chamomile.
5) Avoid heavy meals late at night.
6) Avoid using any devices that stimulate you too much e.g computer screen, TV etc.
7) Try to do something relaxing before going to sleep. For example a warm bath with some calming oils like lavender.
8) If you can’t get to sleep instead of getting angry or frustrated, just wake up and try to relax and go back to sleep when you’re tired again.
9) Avoid watching the clock all night.
For more information on sleep hygiene see the NICE guidelines which are the recommended clinical guidelines in the UK.
It has also been shown in the NICE guidelines that evidence from one small randomised controlled trial suggests that exercise has a beneficial effect on both the quality and quantity of sleep. It should, however, be avoided 4 hours before going to sleep but is beneficial earlier in the day.
Cognitive and Behavioural Interventions
Cognitive and behavioural treatments could also be applied which are fully described in NICE guidelines. An example is teaching a person suffering from insomnia progressive muscle relaxation in which one can imagine all the muscles in the body slowly relaxing. This powerful relaxation technique relaxes the body, which can then lead to relaxation of the mind.
Following these basic steps often cures the problem without the need for any further help but if poor sleep is still an issue then visit your GP who will be happy to help.
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