- This article is the next in The Conversation’s six-part series on insomnia, which charts the rise of insomnia during industrialisation to sleep apps today.
- Do these sleep problems make you feel fatigued, strung-out, or exhausted during the day?
- Read more:
A short history of insomnia and how we became obsessed with sleep
What not to do
These probably won’t help:
spending more time in bed often results in more time spent awake in bed, which can make insomnia patterns worse
drinking coffee and taking naps might help get you through the day. But caffeine stays in the system for many hours, and can disrupt our sleep if you drink too much of it, especially after about 2pm. If naps last for more than 30 minutes, or occur after about 4pm, this can reduce your “sleep debt”, and can make it more difficult to fall asleep in the evening
drinking alcohol might help you fall asleep quicker, but can cause more frequent awakenings, change how long you sleep, change the time spent in different “stages” of sleep, and reduce the overall quality of sleep. Therefore, it is not recommended as a sleep aid.
Read more:
Why do I fall asleep on the sofa but am wide awake when I get to bed?
What to do next?
- So, the next stage is a type of non-drug therapy known as cognitive behavioural therapy for insomnia (or CBTi for short).
- It involves education about sleep, and offers psychological and behavioural treatments that address the underlying causes of long-term insomnia.
- Some GPs are trained to offer CBTi, but it’s more usual for specialist sleep psychologists to offer it.
- But many psychologists will also charge a gap fee above the Medicare subsidy, making access to CBTi a challenge for some.
What if that doesn’t work?
- Some lifestyle and work factors, such as shift-work, might also require management by a specialist sleep doctor.
- Read more:
Counting the wrong sheep: why trouble sleeping is about more than just individual lifestyles and habits
What about sleeping pills?
- Sleeping pills are not the recommended first-line way to manage insomnia.
- Read more:
Some reasons why you should avoid sleeping pills
Are there new treatments? How about medicinal cannabis?
Two newer drugs, known as “orexin receptor antagonists”, are available in Australia (suvorexant and lemborexant). These block the wake-promoting pathways in the brain. Early data suggests they are effective in improving sleep, and have lower risk of potential side-effects, tolerance and dependence compared with earlier medicines. However, we don’t know if they work or are safe over the long term.
- Medicinal cannabis has only in recent years been studied as a treatment for insomnia.
- In an Australian survey, more than half of people using medicinal cannabis said they used it to treat insomnia.
What now?
- Your GP can help identify and manage these.
- Your GP can also help you access other treatments if your insomnia is more long term.
- Dr Sweetman reports previous research funding and/or consultancy work for; the National Health and Medical Research Council, The Hospital Research Foundation, Flinders University, Flinders Foundation, ResMed, Philips, Cerebra, Re-Time, and Australian Doctor.
- Nicole Grivell is involved in the Australasian Sleep Association as a co-chair of the Primary Care Council and as a member of the Conference Committee.
- She has previously received PhD funding from the Flinders Foundation in the form of a Nick Antic Sleep Research PhD Scholarship.
