A lady in her early 50s had come for a repeat of her zopiclone. She had been on it for years. When I suggested a trial of cutting down, she was quite resistant. She told me she would love to if there was something else I could do to help her sleep. She told me she had tried sleep hygiene.<\/p>\n
I said I would find out, and would see her in 4 weeks with a solution.<\/p>\n
I searched online for studies into the non pharmacological management of insomnia. After sleep hygiene, CBT for insomnia seemed to be the best approach.<\/p>\n
Old me: Wait. What do you mean CBT for insomnia? Like the CBT for depression?<\/strong><\/p>\n New me: Exactly. It\u2019s about becoming aware of the distorting effect your mind can have processing what\u2019s really happening, and how this fighting this distorted view is what makes life difficult. NHS choices mentions a few centres<\/a> which did it.<\/p>\n Old me: But what exactly does CBT for insomnia involve?<\/strong><\/p>\n New me: The treatments are summarised on NICE CKS<\/a>. \u00a0Most insomniacs can identify with one or more of the following patterns:<\/p>\n \u201cI keep checking the clock throughout the night, and get more frustrated as I rack up sleepless hours\u201d<\/p>\n \u201cI take extra naps during the day to compensate for my problems sleeping at night\u201d<\/p>\n \u201cI lie in bed worrying that I\u2019m not getting to sleep\u201d<\/p>\n You can start by explaining a few things:<\/p>\n Old me: So what behavioural change do you suggest?<\/strong><\/p>\n New me: The first thing I\u2019m suggesting is Sleep Restriction<\/strong>. In addition to strict sleep hygiene, the patient should avoid napping or having an early night. In fact, if they need to get up at 8am, they are only allowed to sleep after midnight. They might feel more groggy for the next day or ten, but eventually they will look forward to midnight and collapsing asleep. They will be too tired to care about not getting to sleep and instead just fall asleep. <\/em><\/p>\n Then after a while of undisturbed sleep until the alarm rings, you can set the bedtime gradually earlier until you find a level of sleep that maintains sleeping through the night with feeling fully refreshed. Bear in mind that this number of hours is not the be all and end all. The patient should realise that they will naturally compensate for any sleep deficiency in the next sleep cycle by drifting off quicker. It\u2019ll all work.<\/p>\n Old me: What are you basing this on?<\/strong><\/p>\n New me: Most of the principles are in\u00a0Overcoming Insomnia<\/a> by Edinger and Carney. You can prescribe this book from the library in our practice. There\u2019s a manual to train you and a workbook<\/a> to train the patient.<\/p>\n\n