Treating insomnia and restoring normal sleep patterns
At GP Matters, we offer assessment, treatment and advice for a wide range of sleep problems, including insomnia, sleep apnoea, snoring, and disruptions to your body clock (such as jet lag or shift work).
This service is for patients aged 18 and over.
Private GP / PGDip Sleep Medicine
Treating Sleep Disorders: Insomnia, Sleep apnoea, snoring, disruptions of the body clock (jet lag or shift work).
Initial appointment (45 min) - £200
Follow up appointments (30 min) - £150
This service is designed for adults aged 18 and over, who:
* Struggle to fall asleep or stay asleep
* Feel anxious or frustrated about sleep
* Have tried self-help strategies without success
* Want professional support rather than sleeping tablets
If your sleep problems have been ongoing for weeks or months, CBTi is the recommended first-line treatment.
CBT-i (Cognitive Behavioural Therapy for Insomnia) is a structured, evidence-based approach that helps you rebuild a healthy sleep pattern.
It focuses on:
* Improving sleep consistency and quality
* Reducing time spent awake at night
* Breaking the cycle of sleep anxiety
CBTi is recommended by the NHS and international sleep organisations as the most effective long-term treatment for insomnia.
Your initial assessment is a 45 minute consultation with Dr Katie Usher (PGDip Sleep Medicine).
During this session, you will:
* Discuss your sleep history and current difficulties
* Identify the factors maintaining your insomnia
* Receive clear, personalised recommendations
* Agree on next steps for your treatment plan
Typically, CBT-I is a brief, short-term therapy that most people complete within four to eight sessions. The typical frequency of sessions is weekly or every other week.
There is no obligation to continue beyond the first session.
CBTi is effective and long-lasting. There is a large body of evidence, from more than 200 randomised controlled trials (RCTs), for CBTi being an effective and long-lasting treatment for 50%–70% of patients. These findings relate to CBTi as a therapeutic approach, not to any specific programme.
CBT takes longer than drugs to produce sleep improvements but these improvements are sustained over time.
The efficacy of Cognitive Behavioural Therapy for insomnia delivered in person has been robustly researched and supported among individuals across all age ranges. CBTi has also been found to be effective for more complex insomnia with comorbid medical and psychiatric conditions.
Source: Sleepstation
CBTi is now the recommended first line treatment for insomnia. In the past medication was often used in the hope of a quick fix.
But sleeping tablets were only recommended as short-term solutions and carried the risk of unwanted side effects.
If you’re looking for a long-lasting, drug-free solution to your sleep problems, CBTi could be the alternative for you.
CBTi has been shown to be as effective, if not more, than conventional sleeping tablets in reducing the time it takes to fall asleep and increasing your total sleep time.
CBTi also has two major advantages over sleeping tablets:
1- CBTi has long-lasting effects
As soon as you stop taking sleeping tablets, you lose any benefit you were experiencing to your sleep. Sometimes you can even end up with rebound insomnia, so you’re back where you started before you took the pills. But the positive effects of CBTi can last well after your therapy has finished, for up to a year or even longer in some cases.20 21
2- CBTi has almost no side effects
Compared with sleeping tablets, CBTi has next to no side effects. In the early stages, you might experience a temporary increase in daytime sleepiness due to the sleep restriction component, but few other side effects have been noted. There’s also no possibility of dependence or addiction forming.
Source: Sleepstation
Sleep disorders are conditions that regularly prevent you from getting enough good quality sleep. You might struggle to fall asleep, wake up frequently during the night, or find yourself feeling tired even after a full night’s rest.
The most common form of sleep disorder is insomnia, defined by the American Academy of Sleep Medicine as the inability to initiate or maintain sleep, or to obtain good quality sleep despite having the opportunity to do so, alongside daytime consequences such as fatigue, difficulty concentrating or low mood.
While occasional poor sleep is common, a persistent sleep disorder can impact your physical health, mental wellbeing, relationships and daily functioning.
If you have problems sleeping you may be experiencing Insomnia, which is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning. It's a common problem believed to regularly affect around 1 in every 3 people in the UK. Insomnia can be short-term or chronic (ongoing).
Short-term insomnia is common. Causes may include stress, anxiety or depression, the environment (i.e. noise, comfort, temperature), shift work and/or recreational drugs like cocaine or ecstasy. Short-term insomnia usually lasts for days or weeks. Chronic insomnia lasts for a month or longer. Most cases of chronic insomnia are because of other problems, such as mental health conditions, medical conditions, medication, other sleep disorders such as sleep apnoea, restless leg syndrome and/or substances (i.e. caffeine, alcohol, nicotine).
If you suffer from problems sleeping regularly you can work through these sections to help identify the causes and find new ways to improve your sleep.
Types of Insomnia
Short-Term Insomnia
Also known as acute insomnia or adjustment insomnia, this is a brief episode of difficulty sleeping. Short-term insomnia due to a stressful life event, such as the loss of a loved one, a disconcerting medical diagnosis, a pandemic, rebounding misuse, or a major job or relationship change. This insomnia lasts for less than three months, and symptoms may fade on their own as time passes.
Chronic Insomnia
Chronic insomnia is a long-term pattern of difficulty sleeping. Insomnia is considered chronic if a person has trouble falling asleep or staying asleep at least three nights per week for three months or longer. Some people with chronic insomnia have a long history of difficulty sleeping. Inability to get the sleep they need may be persistent or go away and recur with months-long episodes at a time.
Other Descriptions of Insomnia
Sleep Onset Insomnia describes difficulty falling asleep at the beginning of the night, or in the case of shift workers, whenever they attempt to initiate sleep. It is associated with the idea of tossing and turning without actually being able to get to sleep. The inability to fall asleep means that a person with insomnia of this nature has reduced total sleep time and can feel the effects of that lack of sleep the next day.
Sleep Maintenance Insomnia
Sleep maintenance insomnia describes an inability to stay asleep through the night. Most often, this means waking up at least once during the night and struggling to get back to sleep for at least 20-30 minutes. The fragmented sleep associated with poor sleep maintenance means a decrease in both sleep quantity and quality, creating higher chances of daytime sleepiness or sluggishness.
Early Morning Awakening Insomnia
Early morning awakening insomnia involves waking up well before a person wants or plans to in the morning. Some experts view this as a component of sleep maintenance while others consider it separately. Inability to get their desired amount of sleep can impair a person’s physical and mental function the next day.
Source: NHS
If you have sleep problems you may be able to relate to the following:
Difficulty falling asleep at night
Waking up during the night
Waking up too early and unable to fall back asleep
Not feeling well-rested after a night's sleep
Daytime tiredness or sleepiness
Irritability, depression or anxiety
Difficulty paying attention, focusing on tasks or remembering
Increased errors or accidents
Ongoing worries about sleep
Short-term insomnia may come and go without causing any serious problems, but for some people this can become chronic and last for months or even years at a time. This persistent insomnia can have a significant impact on your quality of life. It can limit what you're able to do during the day, affect your mood, lead to relationship problems and as a result you may find it difficult to boost your self-confidence.
Source: NHS
We know that poor sleep can be caused by a number of factors. It could be caused by something environmental, physiological, psychological or a combination of these factors. It could be as simple as your room being too hot at night, drinking too much caffeine or more complex factors such as illness, medication, anxiety or depression. Sometimes it's not possible to identify a clear cause.
ENVIRONMENTAL FACTORS
You may struggle to get a good night's sleep if you go to bed at inconsistent times, nap during the day, or don't "wind down" before going to bed. A poor sleeping environment does contribute to insomnia – for instance, an uncomfortable bed or a bedroom that's too bright, noisy, hot or cold.
Changes to your sleeping patterns can also contribute to insomnia – for example, because of shift work or changing time zones after a long-haul flight (jet lag).
PHYSIOLOGICAL FACTORS
Drinking alcohol before going to bed and taking certain recreational drugs can affect your sleep, as can stimulants such as nicotine and caffeine. These should be avoided as they can delay sleep initiation and reduce sleep intensity, particularly when consumed in the evening.
Of all medical conditions, pain is the number one cause of insomnia. For people with chronic pain, trouble falling asleep is one of the most prevalent types of sleep disruption, but waking up during the night and waking earlier than desired are also frequent problems.
Medical conditions can affect your sleep, such as:
heart conditions – such as angina or heart failure
respiratory conditions – such as chronic obstructive pulmonary disease (COPD) or asthma
neurological conditions – such as Alzheimer's disease or Parkinson's disease
hormonal problems – such as an overactive thyroid
joint or muscle problems – such as arthritis
problems with the genital or urinary organs – such as urinary incontinence or an enlarged prostate
sleep disorders – such as snoring and sleep apnoea, restless legs syndrome, narcolepsy, night terrors and sleepwalking
long-term pain
Some prescriptions or over-the-counter medications can cause insomnia as a side effect:
certain antidepressants
epilepsy medicines
medicines for high blood pressure, such as beta-blockers
steroid medication
non-steroidal anti-inflammatory drugs (NSAIDs)
stimulant medicines used to treat attention deficit hyperactivity disorder (ADHD) or narcolepsy
some medicines used to treat asthma, such as salbutamol, salmeterol and theophylline
Check the leaflet that comes with any medication you're taking to see if insomnia or sleeping difficulties are listed as a possible side effect.
PSYCHOLOGICAL FACTORS
Underlying mental health problems can often affect a person's sleeping patterns.
Depression
An inability to sleep is one of the key signs of depression. Another sign of depression is sleeping too much or oversleeping. Lack of sleep or personal problems can make depression worse.
Stress
High levels of stress impair sleep by prolonging how long it takes to fall asleep and fragmenting sleep. Sleep loss triggers our body's stress response system, leading to an elevation in stress hormones, namely cortisol, which further disrupts sleep.
Anxiety
Anxiety is frequently connected to sleeping problems. Excess worry and fear make it harder to fall asleep and stay asleep through the night. Sleep deprivation can worsen anxiety, spurring a negative cycle involving insomnia and anxiety disorders.
Source: NHS
There are many different types of sleep aids for Insomnia, including over-the-counter (non-prescription) and prescription medications as well as herbal remedies.
If you have long-term or chronic insomnia, it may be best to look into a treatment that addresses the cause of the problem and not just the symptoms. Cognitive Behavioural Therapy for Insomnia (CBT-I) is often the first recommendation in this case.
Cognitive Behavioural Therapy for Insomnia (CBT-I)
Cognitive behavioural therapy (CBT) has been shown to be a very effective non-pharmaceutical treatment for insomnia. Studies show it can lead to a long-term improvement in sleep quality.
It works by pinpointing the thoughts and behaviours that might be causing your sleep issues and aims to change these. For many people, it can result in significant and sustained changes in sleep behaviours and sleep attitudes.
Prescription medications
Doctors also frequently prescribe sedative antidepressants, antihistamines and, sometimes, small doses of sedative antipsychotics to improve sleep.
Medications do have certain advantages. These include easy accessibility, a simple administration route, and that they generally take quick effect.
Not having to commit to behavioural changes may also be an appealing benefit for some people.
However, sleeping pills can have serious side effects, with addiction counted among them.
Over-the-counter medications and herbal remedies
Certain over-the-counter medications and herbal supplements are advertised as treatments for insomnia.
The problem with non-prescription remedies is that they often only work if taken correctly, in the right does and at a specific time, all of which may need to be tailored individually to you.
Which of these remedies will work for you will all depend on the type and duration of your insomnia and your symptoms.
For this reason, you should always speak to a doctor before taking any sleep aid. They'll support and monitor you to track its effectiveness.
When it comes to any medication for insomnia, whether prescription or over-the-counter, it's important to remember that you're not addressing the causes of your sleep issues. Medication can be very effective for acute symptoms, but it won't relieve chronic insomnia in the long-term.
Living with insomnia can be very difficult, but there are steps you can take that might help. These self-help guides, websites and apps may be helpful as you work towards improving your sleep. Like any new skill, it may take a bit of time and practice before you notice any changes.
We recommend you engage with Sleepio in the first instance. This is a free 6 week online program designed by sleep experts and based on cognitive and behavioural techniques. Click here to access the Sleep Improvement Programme.
Self-help Guides
NHS Inform Sleep Self-Help Guide
Wellbeing Glasgow Trouble Sleeping Self-Help Guide
Wellbeing Glasgow Guided Imagery / Progressive Muscle Relaxation Guides
Websites
Sleepio is a sleep improvement program based on CBT. Over the course of six sessions, a virtual sleep expert will teach you evidence-based cognitive and behavioural skills to tackle even the most stubborn of sleep problems.
Wellbeing Glasgow offer information to support you to manage how you feel, change the way that you think about some things and improve your problem-solving skills and confidence
Better Sleep Self-Help
Top Tips
Relaxation Resources
Learn about CBT
NHS Every Mind Matters offers a free Wellbeing Plan. Just answer 5 questions to get your free plan with tips to help you deal with stress and anxiety, improve your sleep, boost your mood and feel more in control.
Citizens Advice Scotland offer advice about benefits, debt problems, legal issues and local services. The Citizens Advice Bureau website has a directory listing its local offices.
Get Active is a great place to start if you are looking to become more active or increase your physical activity. They have a list of options to help you identify classes and activities offered throughout Greater Glasgow and Clyde.
Mind 2 Mind shares other peoples stories with managing sleep problems.
Free Courses
Lifelink offer a variety of free online courses such as ‘Re-Assess your Stress’, ‘Art of Relaxation’ and ‘Coping with Change’. Each 2-hour class is delivered experienced facilitators. Participants with a Glasgow postcode can attend as many classes as they like. You can register directly for these classes without the need for any pre-assessment.
Living Life to the Full offer a course to help you learn new skills and tackle problems in your life that may be causing you to feel low worried or hopeless.
SilverCloud is a website with courses you can do to improve your mental wellbeing. You can learn new ways to deal with the challenges you’re facing. It’s designed by clinical experts, and supported by the NHS and Scottish Government.
SilverCloud is:
secure
supportive
free from stigma
flexible so you can do a course at your own pace
SilverCloud is free, use the code Scotland2020 and an email address to sign up.
SilverCloud courses relevant to Sleep Problems include:
Space for Sleep - This program will teach you the skills for overcoming your sleep difficulties, allowing you to achieve better quality sleep and wake up feeling refreshed. You will learn the causes of poor sleep, track your current sleeping habits and learn techniques to maintain a healthy sleep cycle.
Self-Management Toolkit - This programme is designed to help you to become an optimal self-manager. It teaches you important skills and tools that you will need during periods of change and uncertainty, including problem-solving and goal setting.
Apps
Sleepio
Get Support Now
Some people find that talking with friends and family about their feelings can be a real source of support for coping with distress or suicidal thoughts. It might be helpful for them to map their support network and think about people they could call if their feeling suicidal. Other people may prefer to seek more professional support or call a helpline such as Breathing Space, Samaritans or Shout.
Breathing Space: Call 0800 83 85 87
Samaritans: Call 116 123
SHOUT Crisis Text service also available 24/7 Text SHOUT to 85258
For some people they may be finding it difficult to cope and may think of ending their life, if you are concerned about your mental health and wellbeing, you can contact your G.P. within opening hours. If you feel you are in immediate danger, please call 999 for assistance.
Source: NHS