Sleeping pills

More than 10 million prescriptions for sleeping pills are given each year in England, but medication only offers short-term relief.

'Sleep is fragile. You’ve got to look after it'

Professor Kevin Morgan

Non-drug treatments have been under-used, but sleep experts say that they offer the best long-term solutions to chronic insomnia.

Professor Kevin Morgan of Loughborough University’s Sleep Research Centre says that sleeping tablets treat the symptoms of insomnia, not its causes.

He's been researching psychological treatments for insomnia. He focuses on behavioural change and self-help to promote better sleeping patterns.

It was always assumed that if people had insomnia alongside a more serious condition, then curing that illness would cure the insomnia. These days, insomnia is generally treated as a separate illness.

Before your GP can make a diagnosis, you may be asked to keep a sleep diary, in order to record bedtimes, wake times, hours slept, and quality of sleep each morning.

“Sleep diaries are an invaluable insight into the patient’s sleeping habits. If continued during therapy, they're a useful way of monitoring the outcome of treatment,” says Professor Morgan.

If insomnia is diagnosed, the main treatments are:

1. Sorting out 'sleep hygiene'

Lifestyle, particularly your sleeping habits, have a big impact on your quality of sleep. Addressing so-called 'sleep hygiene' should be the first step in any treatment of insomnia.

Sleep hygiene is a list of lifestyle dos and don’ts. It has proved to be effective in stopping insomnia from getting worse, and making it easier to benefit from further treatment.

“It's a useful first step in treatment, and sends the important message that behaviour and lifestyle choices can influence sleep quality,” says Professor Morgan.

Habits such as drinking too many caffeine-based drinks (including coffee, tea and some energy drinks) or exercising too close to bedtime will affect your sleep.

“If you have a sleep problem, it’s worth looking at your personal habits. It could be that your sleep is being ruined by your regular expresso before bed,” says Professor Morgan.

“Sleep is fragile,” he says. “You’ve got to look after it.”

2. Cognitive behavioural therapy (CBT)

Once sleep hygiene has been addressed, and there’s no improvement in your insomnia, CBT is the next step. It's a package of treatments that usually includes sleep restriction, stimulus control, cognitive therapy and relaxation techniques.

  • Sleep restriction: Some people with insomnia may benefit from a sleep restriction programme that allows only a few hours of sleep during the night at first. Gradually, the time is increased until you achieve a more regular night's sleep.
  • Stimulus control: This therapy rebuilds the association between the bedroom and sleep by limiting the amount of time that you spend awake in bed. “The environment can stimulate behaviour,” says Professor Morgan.
  • Cognitive therapy: Thought-blocking therapies are used to reduce the anxiety about not falling asleep. Professor Morgan says: “Cognitive therapy can help to break this vicious circle by teaching you a different way of worrying. Do your worrying at a different time, write down your fears, and discipline yourself not to worry about things around bedtime.”
  • Relaxation therapy: There are specific effective techniques that can reduce or eliminate anxiety and body tension. As a result, the person's mind stops racing, the muscles relax, and restful sleep can follow.

3. Sleeping tablets

GPs are advised to turn to hypnotic drug therapy only after considering non-drug therapies, such as those outlined above.

Benzodiazepines (such as Temazepam or Loprazolam) and the newer 'Z medicines' (such as Zopiclone or Zolpidem) are the preferred drugs for insomnia.

Both types of drugs work in a similar way. If one doesn’t work, swapping to the other is unlikely to have a different effect.

“These drugs are very effective sleep inducers,” says Professor Morgan. “They work immediately, they’re not toxic, and they've been shown to be safe in overdose.”

But they're only recommended for the short-term treatment of insomnia – up to four weeks.

“Very few insomnia cases last only four weeks,” says Professor Morgan. “Most clinical insomnias are chronic. So most of these drugs are prescribed for longer than they should.”

In any case, the drugs lose their effectiveness over time because the body gets used to them. By that stage, the person has become psychologically dependent on them.




Page last reviewed: 14/03/2012

Next review due: 14/03/2014

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The 4 comments posted are personal views. Any information they give has not been checked and may not be accurate.

AranQuin said on 24 February 2013

I'm about to be assessed for CBT. Point is, I've suffered chronic insomnia for over 50 years so obviously have sorted out the sleep hygiene stuff. For all this time I've received meds that do work and haven't had to increase over time. So this latest wisdom about drug therapy only working for a few weeks is rubbish and presumably motivated by someone who does not personally experience this "disorder". The doctors recently sought to cosh me with amitriptyline which was a disaster - but it isn't addictive, they say. No - true, it's repulsive. So I'm down for CBT.

However, my family circumstances are such that our kids are still with us - we are still a family together, it's how it is these days (2013) with the chances for kids to become self-supporting severly attenuated - and sleep deprivaton does NOT sit well with me. I get aggressive, angry, lose motivation to diet, to do keep fit and I'm unpredictable even to myself - which is causing unrest throughout the family. (No violence thankfully.) So what I didn't learn from this article is what CBT involves. These therapies usually involve multiple sessions which means my family and I are going to suffer from the point the meds are withdrawn until the CBT works.

Well, I'm old enough and spiritual enough to know my way forward.

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User719918 said on 18 October 2012

I was on Temazepam which I didn't have any problems with but was told it had been withdrawn I now use Zopiclone but find I am very depressed and drowsy despite getting an ok nights sleep not good!

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Brangane said on 29 June 2011

Most articles on insomnia contin useful info about how to get to sleep. I have no problem getting to sleep whatever time I go to bed. However, I have a big problem in staying asleep. Quite often, even though I go to sleep as soon as my head hits the pillow, I will be wide awake again within an hour and find it impossible to get back to sleep. This leads to long nights in front of Tv or reading and much tiredness the following day. I follow sleep-hygiene rules and don't eat or drink after 8p.m. If anyone has a solution to this problem, which has dogged me for years, I would be most interested.

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mrmister said on 20 September 2010

I agree with the above comment. I have been taking Zopiclone for nearly three years and without them I will lay awake all night.

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Media last reviewed: 18/03/2013

Next review due: 18/03/2015