Sleep problems

Good quality sleep is important for physical health and mental wellbeing.  We all need different amounts of sleep.  For most people, between 6 and 9 hours is enough.  As a rule children need more sleep than adults as they are still growing/developing. As we get older, we generally need less sleep.  If you are less active during the day you are likely to need less sleep.

If you wake feeling refreshed and are not sleepy during the day, you are probably getting enough sleep.

Poor sleep is usually a temporary problem and the odd sleepless night is not usually anything to worry about.  However, more persistent lack of sleep can be distressing and start to affect your daily life and relationships.

Poor sleep can include:

• Struggling to get off to sleep
• Struggling to stay asleep
• Not feeling refreshed on waking 
• Feeling tired and irritable during the day

Lots of things can cause poor sleep but some common examples include:-

• Stress, anxiety or depression 
• Snoring and sleep apnoea
• Leg cramps and restless legs
• Needing to pass urine at night
• Hot flushes (e.g. around the time of menopause)
• Pain (e.g. joint pain from arthritis)
• Difficulty breathing (e.g. in some heart and lung conditions)
• Caring for a newborn baby
• Stimulants such as alcohol, caffeine and nicotine 
• Prescription medicines (e.g. steroids, beta-blockers, water tablets, some antidepressants)
• Screen time before bed
• Shift work

You might have heard the phrase “sleep hygiene “.  Sleep hygiene refers to healthy habits and behaviours to promote better sleep.  The principles of sleep hygiene include:

• Reduce your overall caffeine intake and avoid caffeine for 6 hours before bed
• Don’t smoke before bed
• Avoid drinking alcohol for 4 hours before bed
• Try not to eat a heavy meal just before bed 
• Avoid anything too mentally challenging before bed (e.g. studying)
• Avoid using your mobile phone, tablet or laptop before bed
• Take regular daytime exercise but try to avoid any strenuous exercise immediately before bed
• Avoid napping during the day
• Establish a routine and get up at the same time each day
• Once you are up and about, avoid going back into your bedroom until bedtime
• Don’t use your bedroom for activities such as work, eating or watching television
• Ensure your bedroom is dark
• Avoid extremes of temperature in your bedroom
• Make sure your bedroom is quiet 
• Make sure your bed is comfortable 
• Try to relax before bed (e.g. take a warm bath, have a warm drink, play some soft music or white noise)
• Turn your clock away from you to avoid “clock-watching”

If you haven’t managed to get off to sleep after 20-30 minutes, get up, do something you find relaxing until you feel sleepy, and then go back to bed.

Relaxation exercises such as deep breathing or progressive muscular relaxation can help promote sleep.

If your sleep is persistently or severely disturbed, psychological treatments such as behavioural and cognitive therapies might help to re-train your brain.

Your GP may refer you to a sleep clinic if you have symptoms of another sleep disorder such as sleep apnoea.

Sleeping Tablets

In years gone by sleeping tablets were commonly prescribed.  Examples include Benzodiazepines (diazepam, temazepam, nitrazepam) and Z-drugs (zopiclone, zolpidem).

However, sleeping tablets are no longer commonly used and your doctor will not routinely offer such medicines other than in exceptional cases such as bereavement.

Where a sleeping tablet is prescribed, it will be a very short course, usually for no longer than a week.  The lowest effective dose should be used for the shortest possible time.

Possible problems with sleeping tablets include:

• Drowsiness the following morning which might affect your ability to drive or operate machinery
• Falls in the middle of the night (e.g. if you get up in the night to go to the toilet)
• Tolerance, meaning that over time the medicine has less effect and higher doses are needed to get the same effect
• Addiction
• Interactions with other medicines 
• There is some evidence linking sleeping tablets to dementia

Melatonin

Melatonin is a naturally occurring hormone that can help insomnia.

It should only be used for short periods of time and can cause other problems such as drowsiness, irritability, dizziness,  constipation and weight gain.

Whilst Melatonin does have a license for use in those aged over 55 in England, Cambridgeshire and Peterborough Integrated Care System does not support prescribing of Melatonin for adults in Primary Care so your GP will be unable to provide this medicine for adults.

Melatonin may be prescribed in  Cambridgeshire and Peterborough for children with sleep disturbances associated with learning difficulties, Attention Deficit Hyperactivity Disorder (ADHD) or autism.  However, it can only be prescribed in Primary Care on the advice of a hospital specialist and your GP will not be able to initiate this medicine without a specialist review first.

Over the counter medicines 

You can buy over the counter medicines for sleep at your local chemist without a prescription.

These remedies often contain antihistamines (medicines commonly a used to treat hayfever).  

Such medicines do work, but they can make you sleepy/drowsy the following morning so if you do choose to use them, take the warnings very seriously and avoid driving or operating machinery the following day.

These remedies can also interact with other medicines so it is important you tell your Pharmacist if you are taking any other medicines, especially those prescribed by your doctor.