Insomnia - tired of not sleeping?

What is insomnia?

Insomnia is the condition of difficulty in going to sleep and keeping asleep, or in waking during the sleep period or too early and being unable to go back to sleep, resulting in insufficient sleep and awaking feeling tired, listless and unrefreshed.

Can I get any medication to help with sleep problems?

The Online Clinic can prescribe Melatonin to aid sleep. To proceed, please complete a short online assessment that will be reviewed by one of our doctors.

Who gets insomnia?

Many factors cause insomnia. Commonly, stress and worry about things going on in your life, or even about staying awake may stop you from sleeping. However, stimulants (e.g. caffeine in coffee, nicotine in cigarettes, and recreational drugs), too much alcohol, jet lag, and some medicines can keep you awake. Some mental health disorders can disrupt sleep patterns, such as depression and anxiety. Additionally, physical health problems, such as heart, breathing and nerve disorders, hormonal imbalances, or those associated with your ‘water works’ may keep you awake. Perhaps more obvious causes are constant pain, joint and muscle complaints, and other sleep disorders (e.g. restless legs syndrome).

Why do we need sleep?

While you sleep your body is not only resting but actively producing and repairing its tissues. Energy levels are restored to your brain and body. The health of your immune system is maintained so that you can readily fight off illness. Importantly, regulation of some hormones (natural chemicals) in the body that control your appetite occurs during sleep, ensuring that you balance your energy (calorie) intake and expenditure to prevent weight gain or loss.

What happens when you go to sleep?

During a period of sleep, all our senses and voluntary muscles become inactive; you enter a relatively unconscious state. Our heart beat and breathing slow and our blood pressure drops. Our body enters a cycle of rest, which recurs 4-6 times a night. Most of the time, we are in a period of non-rapid eye movement (NREM) sleep, which comprised three or four stages:

• Stage 1: Drowsiness; transitioning from being awake to asleep
• Stage 2: Light sleep; the brain and body functions slow down
• Stages 3 and 4: Deep reviving sleep, when it is difficult to be awakened

We then enter rapid eye movement (REM) sleep, when our brains are active and we dream. During our sleep period, we alternate between NREM and REM sleep about every 90 minutes, spending about 20% of the time in REM sleep.

How much sleep do you need?

Generally, most people require about eight hours sleep to awake refreshed and function normally. However, the amount of sleep an individual needs will depend on several factors, such as their age (with babies and young children requiring most sleep), lifestyle, and state of health, as well as an individual’s internal ‘body clock’.

What happens if I don’t get enough sleep?

You likely know what it feels like when you have had a ‘bad night’s sleep’. Tired, short tempered, lack of concentration. Occasionally, while we don’t feel our best, this will not do us any harm. However, on a regular basis, lack of sleep can have a major effect on your mental and physical health and on your overall quality of life. Deprived of sleep, and therefore the time that your body has to carry out the work to maintain good health, your mental well-being suffers - you become irritable, anxious, and develop problems concentrating, decision making, and remembering. Your physical health also suffers - you increase the risk of catching infections, experiencing dizzy spells and headaches, becoming overweight, developing diabetes, heart disease and pain, and reducing your sex drive.

How you help yourself to get more sleep and treat insomnia

Keep to a routine, so that your brain and your internal body clock ‘learn’ when it is time to sleep and be wake. Set these times according to your daily schedule. Ensure your bedroom is designed for sleep, with a comfortable bed and no television, computers, or other electronic devices. Create a peaceful, quiet and dark area that is not too hot and stuffy. You should have a period of relaxation before going to bed - you will have your own style but it may include a warm bath, reading, listening to music, relaxation techniques, or gentle exercises. Off-load your concerns by writing a ‘to do’ list before you go to bed rather than when in bed.

A few don’ts - drink caffeine (in coffee and tea), over-eat, drink too much alcohol, or smoke. You may find that keeping a sleep diary useful, i.e. documenting your sleep period, for example, your sleep/wake times, if you were worried, and what you ate and drank. A sleep diary could answer why you suffer from insomnia.

How is insomnia treated?

Insomnia may be treated by behavioural therapies and medicines that both work by reducing your brain’s level of arousal. Behavioural therapies include cognitive behavioural therapy, which alters your thinking and reactions that cause your wakefulness. Some herbal remedies (e.g. chamomile) may relieve insomnia, and antihistamines can induce sleep but cause daytime drowsiness. Melatonin naturally occurs in the body and promotes sleep by regulating the body’s sleep cycle. Melatonin is also a prescription drug in the UK and this medication can be prescribed for short periods through this clinic. We do not prescribe other types of sleeping pills through The Online Clinic. Sleeping pills are exactly that - they make you sleep but they lose their effectiveness with persistent use. Sleeping pills are not the doctor’s first treatment choice. Sleeping pills don’t tackle any underlying problem, have considerable side effects, and are ‘addictive’. So-called Z meds and benzodiazepines are sometimes prescribed for short periods but they are not appropriate for online prescribing.

When should I get help for insomnia?

Now and again we all have difficulty in sleeping. However, when insomnia starts to generally disrupt your daily life and affect your health and relationships, then you should seek your doctor’s help who will review your lifestyle and general health, and suggest some ways to alleviate the problem. We can provide advice as to whether or not you may benefit from a short course of Melatonin or whether you need to see your GP.