Question: Since last December I’ve had virtually no sleep, which is depressing. Sometimes I manage to fall asleep at 5am, but I need to get up by 6am. I’ve tried meditation, yoga, pilates and I’ve considered hypnosis. I know about sleep hygiene and am trying cognitive behavioural therapy. I’ve been prescribed short courses of sleeping tablets — great for a week, then it’s back to square one. Is there anything new I can try?
Gill Wittmann, Leeds.
Answer: What you have is chronic insomnia, which not only hampers one’s ability to function effectively during the day, but can profoundly affect health.
Indeed, insomnia has been linked to a raised risk of cardiovascular problems, such as high blood pressure and heart attacks, as well as depression and anxiety.
Insomnia is a common complaint, affecting nearly a fifth of patients seen by GPs. And it becomes more prevalent with age — just 12 percent of elderly patients have normal, satisfying sleep patterns, one study found.
Earlier in my career the solution was always a prescription for sleeping tablets. But these haven’t lived up to their promise — they provide some hours of sleep but without curing the fundamental problem, and can lead to dependence.
I regret to report that there are no new drugs that might help you. But we know there are various strategies — often used at specialised sleep clinics — that are extremely worthwhile over time, although these must be practised diligently.
These treatments are centred on changing behaviour. One of the most important is good “sleep hygiene”, and I will explain the rules for the sake of other readers.
Individually each rule may seem obvious, but together they will prove successful.
*Sleep as much as you need to feel rested, then get out of bed; do not force sleep — if you can’t sleep, then get up; avoid tea or coffee after lunchtime; avoid alcohol in the hours immediately before bedtime.
*Give up smoking, as nicotine is a stimulant; do not go to bed hungry; ensure the bedroom is dark, quiet, neither too cool nor too warm (the ideal temperature is around 18 degrees); make a list of tasks and concerns before you settle down to sleep so worries don’t keep you awake; exercise daily; do not use any screen device before bed because the light can suppress the release of the sleep hormone melatonin.
Even if following these rules has not yet helped, continue to adhere to the full list meticulously, and consider further measures.
One option is relaxation therapy, although it seems this has not proved helpful for you so far. My advice is to try using a phone app such as Headspace, which provides guided meditation sessions, for ten minutes each day, once again making this a long-term strategy.
Another relaxation technique is biofeedback — where sensors are placed on the skin to record muscle tension or brain rhythms; this information is then displayed on a screen, and with practice you learn to slow your breathing and so relax. There are biofeedback units you can buy for home use.
Sleep restriction, which is taught by therapists at sleep clinics, may also be useful. It involves estimating the number of hours that you actually sleep, then reducing your total time in bed each night to this average sleep length, with firmly enforced bedtime and awakening times.
Once sleep improves, the amount of time permitted in bed can be gradually increased.
Cognitive behavioural therapy (CBT), a talking therapy which is usually given in combination with other techniques, can also help -here a skilled therapist helps you deal with the anxiety and negative thoughts that accompany insomnia. The chronic insomnia that you describe merits the attention of a specialist sleep clinic, and hopefully your GP will refer you.
If not, then the least I would suggest is that your cognitive therapist is specialised in treating a long-term sleep disorder.
Daily Mail