To sleep or not to sleep
Insomnia (and sleep disturbance) is one of the most common presenting symptoms in the primary care setting. While distressing in itself, insomnia also increases vulnerability to depression.
A recent article in Australian Family Physician reports a strong association between depression and insomnia with up to 40% of people who suffer from depression, anxiety or other psychiatric disorders reporting sleep disturbance.
Initial management of a patient with sleep disturbance could involve:
• Taking a sleep history – sleep patterns, duration, bedtime routine;
• Discussing drug and alcohol use – including non-prescription drugs, caffeine and nicotine;
• Noting any relevant medical conditions that may interfere with sleep, such as snoring or sleep apnoea; and
• Recording psychological history and current mood.
When a patient is establishing improved sleep hygiene, routine is critical. Getting up at the same time each day helps reset the patient’s diurnal rhythms. A consistent waking time has been shown to be as important as a consistent bedtime.
Tips for improving sleep quality
• Regular exercise promotes sleep;
• Avoid stimulating activities before going to bed;
• Reduce stimulation such as noise or lights;
• Avoid caffeine within 8 hours of bedtime;
• Avoid alcohol and smoking within 2 hours of bedtime;
• A ‘wind down’ or relaxation routine can reduce anxiety and assist sleep;
• Put the bedside clock out of view to avoid ‘clock watching’ at night.
Establishing a healthy sleep routine may also require therapeutic intervention to interrupt insomnia and reset sleep patterns. Drug interactions, particularly with antidepressants, must be carefully considered when prescribing sleep medication.