Tuesday 24 April 2018

Dear Dr Nina: I'm tempted to use pills to fix my insomnia

Photo posed
Photo posed

Nina Byrnes

I'm in my sixties and have been suffering with insomnia for a decade or more. I rarely sleep more than three or four hours a night. I've tried everything to combat it but nothing seems to work. I used to take sleeping tablets but stopped several years ago as I was afraid of becoming addicted . But my GP prescribed me a short course of Ambien more recently and they really did work for me. I was able to get a full seven hours and I felt so much better. I know the doctor is reluctant to give me more pills, but are there really serious side-effects in taking pills in the long term?

Dr Nina replies: Sleep disorders (insomnia) are very common. Fifty per cent of people over 65 have some form of sleeping difficulty.

In order to help improve sleep, it is really important to try and identify the cause of insomnia. Potentially treatable causes include sleep apnoea, depression, thyroid problems, menopausal symptoms, bladder problems and pain.

Sleeping tablets are not the answer. They can help give a few nights' sleep in the short term, but they should never be used for more than a few days as they have a high risk of dependency and, particularly in the elderly, increase the chance of falls, and daytime sleepiness and accidents.

They also interact with alcohol and other drugs. Studies have suggested that those on long-term sleeping tablets don't actually sleep better than those who avoid medication and it has been suggested that these medications may be associated with memory issues such as dementia.

Good sleep habits are important. Avoid stimulants such as caffeine and nicotine. Alcohol, although making you sleepy, leads to broken and unrefreshing sleep and should not be used as a sleep aid. Avoid large meals late but a light snack may help. The bedroom should be a restful well ventilated space and should only be used for sleep or sex. Avoid having lights on or watching the clock during the night.

Daytime naps should be avoided. Stick to a sleep routine - go to bed and get up the same time every day, even on weekends, no matter how long you have actually slept. Things like a warm bath, reading or soft music can aid relaxation. Keeping a pen and paper by the bed to write down any distracting worries or thoughts can help the mind relax.

Try not to think about falling asleep; it will keep you awake. Exercise in the late afternoon promotes sleep but exercising too late at night disrupts it.

Cognitive behavioural therapy has been scientifically proven to help improve sleep. Working with a therapist, your negative patterns are challenged and replaced, leading to improved sleep and wellbeing.

Sleep restriction has ironically shown to help improve insomnia. This involves initially only staying in bed for the hours you can actually sleep. So if you have been able to sleep for five hours, then go to bed for this time - once you are sleeping 100pc of five hours, then increase the time in bed by about 10 to 15 minutes at a time, until you sleep for most of your time in bed.

Review any medication you are taking with your doctor as some medication such as steroids, asthma treatments or some heart medication can disrupt sleep. Ensure you are taking adequate painkillers if you have a painful condition that could be keeping you awake.

There are some herbal remedies that have been reported to help sleep - they include lavender, camomile, and valerian. Melatonin is a hormone naturally produced at night and there are some reports suggesting it may help, however long-term safety has not been proven. Melatonin is a prescription-only product in Ireland.

With motivation and good sleep hygiene, most episodes of insomnia should pass.

If you have any health queries for Dr Nina Byrnes, please email drnina@independent.ie. Please note that Dr Nina cannot enter into individual correspondence

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