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July 1, 2013

“O sleep! O gentle sleep!john gaap_448x480

Nature’s soft nurse, how have I frighted thee,

That thou no more wilt weigh my eyelids down

And steep my senses in forgetfulness?”

-Henry IV, Part 2 (Act 3, Sc. i), Shakespeare


The word “insomnia” is Latin for “no sleep.” Somnus- the Roman God of sleep-  was the twin brother of Mors (“Death”) and the son of Nox (“Night”).

In medicine, insomnia refers to difficulty falling asleep, difficulty staying asleep or non-refreshing sleep. It occurs in the context of daytime fatigue, poor concentration, irritability and impaired function despite adequate opportunity for sleep.

Doctors distinguish acute insomnia (less than four weeks in duration) from chronic insomnia (more than four weeks in duration). This distinction allows us to identify the probable cause, classify the type of insomnia, and guides appropriate treatment.

You should use a sleep diary to plan your treatment. Here are some instructions to help you record a comprehensive sleep log.

Treatment of Insomnia

There are three components to the successful treatment of insomnia. They are:

1. Sleep hygiene.

2. Cognitive-Behavioural Therapy, and

3. Medication.

Changing sleep habits, employing relaxation techniques, and seeking cognitive therapy are preferred for chronic insomnia and often more effective than drugs.

Step 1: Sleep hygiene

Sleep hygiene refers to actions that tend to improve and maintain good sleep. Click on this link to follow the rules for a good night’s sleep.

Step 2: Cognitive-Behavioural Therapy

Because of the close connection between behaviour and insomnia, behavioural therapy is often part of any treatment for insomnia. Cognitive-Behavioural Therapy for insomnia is administered by sleep or behavioural specialists. It can deliver a better long-term solution than medication. A combination of several behavioural treatments is typically the most effective approach. The treatments include:

  • Cognitive Therapy: learning to develop positive thoughts and beliefs about sleep

  • Stimulus Control Therapy: creating a sleep environment that promotes sleep

  • Sleep Restriction: following a program that limits time in bed in order to get to sleep and stay asleep throughout the night

  • Relaxation Therapy: such as yoga, meditation, and guided imagery

Online help: Sleepio, Sleep Healthy Using the Internet (SHUTi), CBT-I Coach

Step 3: Medication/Sedatives

Medication should be used only with good sleeping practices and/or behavioural approaches. Ideally, sedatives should only be taken for short periods (2 weeks) because they can be habit forming. They promote daytime drowsiness and confusion and cause nights of poor sleep when stopped.

It is important to consult a doctor when turning to drugs as sleeping aids. There are several options for sedative medications that may be more appropriate for certain patients who suffer from certain diseases.

Patient Handouts

Handouts are available for patients and practitioners:
1. Sleep restriction therapy: sleep-restriction-rev2_tcm28-557887
2. Insomnia management kit

3. BDZ/Z Risks: Sleeping+pills_anti+anxiety+meds_Sedative+hypnotics+(1)

4. Insomnia in the elderly: Insomnia-Older-Adults-QandA

5. Less sedative use for older patients: CWC_BSH_Hospital_Toolkit_v1.3_2017-07-12

For those ≥ 65 years of age, taper ~25% every two weeks, and if possible, 12.5% reductions near end and/or planned drug-free days)

More Links:

Quiet Your Mind and Get to Sleep: Solutions to Insomnia for Those with Depression, Anxiety or Chronic Pain by (2009) by Coleen Carney and Rachel Manber

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