Doctors offer advice for insomnia

People who have trouble falling asleep and staying asleep may want to seek advice from a doctor and avoid long-term use of sleeping pills, medical experts advise.

Good sleep hygiene and a specific kind of talk therapy may help people create good bedtime habits and figure out why they're not sleeping well, the experts say in a new resource for patients published in JAMA Internal Medicine.

Recent research has shown that use of sleeping pills is very common and that the drugs are linked with serious side effects, such as falls and death, said Dr. Michael Incze of the University of California, San Francisco, who co-wrote the one-page primer.

In 2017, the American Academy of Sleep Medicine recommended a form of psychological counseling called cognitive behavioural therapy (CBT) as a first treatment for insomnia, followed by prescription and over-the-counter medicines. CBT focuses on identifying patterns of thinking and behaviour that prevent good sleep.

About 10 per cent of Americans experience chronic insomnia, and about 30 per cent have temporary symptoms.

People who often take sleep medicine "should feel encouraged to talk to their doctor about looking deeper into why they may be having insomnia," Incze told Reuters Health by phone.

Available for free, the new patient page offers practical tips about insomnia diagnosis and treatment. It includes a visual scale of therapy options, ranging from "safe and proven to work" on one end to "potentially dangerous" on the other end.

"Safe and proven" includes sleep hygiene, CBT and short-term use of sleeping pills. "Dangerous" includes combining sleeping pills with opioids or alcohol, use of sleeping pills by older adults and continuous long-term use of sleeping pills.

"It's not always easy to find doctors who do CBT for insomnia right now, even in a big city, and insurance doesn't often cover it," Incze added. "That's where telehealth and mobile apps could come in."

Incze and co-authors recommend starting with good sleep hygiene, that is, creating a peaceful environment for sleep. This includes going to bed at the same time every night and getting up at the same time every morning. Instead of staying in bed lying awake, get up and do something relaxing until you're tired enough to fall asleep, they advise. Also, avoid alcohol and caffeine, and create a dark, quiet environment for sleeping with minimal distractions, which means turning off screens on electronic devices and darkening windows.

"We see insomnia every day in various ages and walks of life, and it can lead us to consider other concerns such as depression, anxiety and medication issues," said Dr. Ada Stewart, a family physician in Columbia, South Carolina who was not involved with the new publication.

Stewart is a member of the Board of Directors of the American Academy of Family Physicians, which also provides free information about insomnia. 

"Most sleeping medicines should only be used for a limited amount of time, usually a week or two, and can be addictive and lead to bad outcomes when mixed with alcohol or other drugs," she told Reuters Health by phone.

Side effects can be stronger in older age groups, so these patients should be particularly careful about sleep medicines, especially if mixing with other prescriptions, she added.

"I like doing a sleep diary with my patients so we can look at what they're doing that can impact the way they're sleeping," she said. "Once I have a sleep diary in front of me, I can see whether it's a more serious sleep disorder and whether they need a sleep study."

Sleep studies include overnight tests to monitor sleep and look for medical conditions such as obstructive sleep apnea. Conditions such as stress, anxiety and breathing issues can also affect sleep. The amount of sleep required by different people varies at different points in life, but the average is six to eight hours per night.

"Most importantly, talk to your doctor about these concerns," Stewart said. "Sleep issues are very common, and many patients don't think to ask questions about it."