Sleep disorders: Management
The management of sleep disorders frequently requires more than the sleep hygiene advice typically provided in general practice, which is often ineffective in real-world settings. While at times this may be due to individuals not implementing the recommendations, it is more commonly because sleep hygiene does not address the underlying determinants of the sleep disorder. Furthermore, different conditions—for example, insomnia disorder and circadian rhythm disorders—require markedly different therapeutic approaches.
Are medications helpful?
Most people who have taken sleep medication have likely been advised that long-term use is not recommended. This is only partially true, as it depends on several factors: 1) the individual, 2) the nature of the problem, and 3) the medication. Medications can be effective for some conditions and, in certain cases, are indispensable. However, they are not without risks; the most common issue associated with sleep medication is daytime sedation.
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It is untrue that all sleep medications are addictive. In the case of benzodiazepines (the class of drugs that includes Valium), concerns exist regarding tolerance, loss of effect, and withdrawal. However, many other sleep medications do not present these issues in the long term. Importantly, medication is often a helpful addition to psychotherapy for sleep disorders, and an integrated approach can be highly beneficial.
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Cognitive Behavioural Therapy for Insomnia (CBT-I)
CBT-I is a non-pharmacological treatment for insomnia disorder and is considered the gold-standard treatment for this condition. Numerous studies have demonstrated its efficacy, with short-term outcomes equivalent to those of sleep medications but superior long-term results. However, it generally requires more time and effort than medication. On average, treatment involves 6–8 sessions, spaced fortnightly to monthly. The core components include:
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sleep restriction,
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stimulus control,
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cognitive restructuring,
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sleep hygiene, and
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relaxation and/or mindfulness techniques.
To learn more about CBT-I, HERE is a useful article from the New York Times.
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