The main aim of insomnia management is to improve sleep quantity and quality, improve daytime function (greater alertness and concentration), and cause minimal adverse drug effects
Acute insomnia
- address the trigger factors which might have resulted in insomnia e.g. – ill health, stress, medication, change in time zone etc.
- provide with or review sleep hygiene practices
- educate and reassure the patient that the symptoms are usually self limiting and are usually caused by a precipitant factor
- short term hypnotic can be considered if symptoms are severe and causes distress about lack of sleep
- if there is no improvement consider comorbid conditions
Chronic insomnia
- healthcare professionals should address any relevant, underlying problems :
- prescribed drugs (eg some antidepressants, withdrawal of sedatives) and non-prescribed drugs (eg caffeine, alcohol)
- physical - pain, respiratory and cardiovascular disorders, neurological disorders, movement disorders, restless leg syndrome and other sleep disorders)
- psychiatric disorders - depression, anxiety, dementia and substance misuse)
- disruption of circadian rhythm - shift work)
- first-line therapy should be non-drug therapy - cognitive behavioural therapy (CBT)
- in patients with significant distress and impact on waking function due to insomnia consider pharmacological treatment (should be used in parallel with non drug treatment and need regular review of medication)
- manage comorbid conditions and refer to a specialist if indicated
Secondary insomnia is treated via treatment of the primary condition.
Whether acute or chronic insomnia, the following non-pharmacologic and pharmacologic treatments can be utilised for treatment (depending on the individual patient and circumstances).
Non paharmacological therapy
- cognitive behavioural therapy (CBT)
- sleep hygiene
- stimulus control
- sleep restriction
- relaxation training
- cognitive restructuring (4)
Pharmacological therapies include (4,5)
- benzodiadepine and Z drugs
- melatonin
- antidepressants
- antipsychotics
- sedating antihistamines
Herbal remedies (5)
- stated that there is insufficient evidence to support the use of herbal medicine for insomnia, though there is a clear need for further research in this area
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