Chronic Insomnia: Effective Treatments and Therapy Options for Restful Sleep
Do you find it difficult to fall asleep? Are you awake for prolonged periods at night? Do you experience fatigue, stress, or exhaustion during the day as a result of your sleep problems? If you’ve been dealing with these issues for months, you’re not alone. According to recent statistics, around 12-15% of Australian adults suffer from chronic insomnia.
If you’ve already tried various remedies like breathing exercises, calming music, a quiet and dark bedroom, adjusting your diet, maintaining a regular sleep schedule, or reducing caffeine intake, but your insomnia keeps coming back after three to four weeks of temporary relief, then it’s time to consider targeted treatments that focus on sleep patterns and behaviors.
Before we delve into the recommended treatments, it’s essential to know what not to do. Spending more time in bed may seem like a logical solution, but it often leads to increased time spent awake, worsening insomnia patterns. Similarly, while coffee and naps can help you get through the day, excessive consumption of caffeine can disrupt your sleep, especially when consumed after 2 pm. Additionally, alcohol may help you fall asleep faster, but it can cause frequent awakenings, shorten the duration of sleep, and reduce overall sleep quality. Hence, it is not recommended as a sleep aid.
So, what should you do next? If your symptoms have persisted for more than a month or two, it is likely that your insomnia requires targeted treatments tailored to your sleep patterns and behaviors. One such treatment is Cognitive Behavioral Therapy for Insomnia (CBTi), a non-drug therapy that has been proven to be more effective than sleeping pills. CBTi typically lasts for four to eight weeks and focuses on educating individuals about sleep while offering psychological and behavioral interventions to address the underlying causes of long-term insomnia.
CBTi can be conducted on a one-on-one basis, in small groups with trained health professionals, or through self-guided online programs. While some general practitioners are trained to provide CBTi, it is more common for specialist sleep psychologists to offer this therapy. Your GP can refer you to a specialist for further guidance. It is worth noting that while some Medicare rebates are available to subsidize the cost of treatment, accessing CBTi may still pose a financial challenge for some due to additional fees charged by psychologists.
Studies have shown that approximately 70-80% of individuals with insomnia experience improved sleep quality after undergoing CBTi, with the benefits lasting for at least a year. However, if CBTi does not yield the desired results, it may be beneficial to consult a specialist sleep doctor who can assess whether other sleep disorders, such as obstructive sleep apnoea, are contributing to your insomnia. Additionally, managing mental health conditions like depression and anxiety, as well as addressing physical symptoms that disrupt sleep, is crucial. In some cases, lifestyle and work factors like shift work may require management by a specialist sleep doctor.
While sleeping pills are not the recommended first-line treatment for insomnia, they can provide short-term relief when necessary. Medications such as benzodiazepines and benzodiazepine receptor agonists have traditionally been used to aid sleep, but they come with side effects including an increased risk of falls, impaired functioning the next day, and the potential for tolerance and dependence. Recently, two newer drugs called orexin receptor antagonists have shown promise in improving sleep with a lower risk of side effects, tolerance, and dependence compared to previous medications. However, their long-term effectiveness and safety remain unknown.
Another topic of interest in sleep research is the use of medicinal cannabis for insomnia. While some individuals report significant benefits from using medicinal cannabis, studies on its effectiveness are still limited. Only one out of the four most robust studies to date demonstrated an improvement in insomnia symptoms after two weeks of treatment. Further research is needed to determine which cannabinoids and doses are most beneficial, as well as the long-term safety and effectiveness of this treatment option.
In summary, if you’ve been experiencing trouble sleeping for a short period of time and none of your attempted remedies have been successful, it is important to identify and address any underlying reasons for your insomnia. Consulting with a GP can help determine the appropriate course of action. For more persistent insomnia, non-drug therapies like CBTi or referrals to specialists may be necessary. While sleeping pills should be used cautiously and as a last resort, newer drugs and even medicinal cannabis are being explored as potential treatment options. Ultimately, finding the right approach to manage chronic insomnia can greatly improve your sleep quality and overall well-being.
