Insomnia counselling

Question 1

explain stages of normal sleep

Answer 1

deep sleep

REM (brain & eyes open, dreaming)

short periods of waking

Question 2

explain insomnia & symptoms to patients & reassure

Answer 2

persistent difficulty falling or staying asleep leading to impaired daytime functioning

includes not being able to go to sleep, waking up early, waking up at night, not feeling refreshed

tired during daytime, reduced concentration, irritable

1 in 5 adults don’t get enough sleep

Question 3

causes insomnia

Answer 3

Temporary problems: stress, a work/family problem, jet-lag, routine change, strange bed etc.

Sleep apnoea: obese people who snore, sleep apnoea: airways narrow or collapse
Anxiety or depression: Other symptoms; low mood, lethargy, poor concentration, tearfulness, etc
Other illnesses: pain, cramps, cough, itch, hot flushes, dementia, mental health problems, etc.

Alcohol - causes broken sleep and early morning wakefulness.
Stimulants: Nicotine, caffeine in tea, coffee, soft drinks, chocolate, some painkillers, illegal drugs
Prescribed drugs: diuretics, antidepressants, steroids, beta-blockers, slimming tablets, painkillers

Unrealistic expectations, Daytime naps, Can be a vicious cycle

Question 4

things that might help

Answer 4

Short periods of waking are normal. Hide alarm clock under bed. Is bed comfortable?

General reduction of stimulants

Do not: smoke or caffeine six hours before bed

Do not: study, have a heavy meal, exercise, drink alcohol just before BUT exercise in day is helpful

Do not: work/eat/TV in bed, sleep during day

Do: get into a routine, switch light straight off, get up at same time daily

Bedroom: too hot, cold, or noisy? Earplugs / eye shades / dark curtains.

‘Wind down’ before going to bed: stroll, bath, reading, warm drink, bed

If not sleeping in 20-30 mins - get up, do something else, go back to bed when sleepy.

Question 5

Non-pharm interventions

Answer 5

Relaxation techniques: progressive muscular relaxation – hypnosis tapes

Sleep restriction: under supervision of doctor - sleep diary, restrict time in bed & increase gradually

Psychologist: CBT: understand & alter unhelpful thought patterns

Question 6

sleeping tablets

Answer 6

Not usually advised. Day drowsiness. Driving and machinery, falls in night, tolerance, withdrawal

If prescribed, usually short course (a week or so) for bad patch.