Doctors offer advice for insomnia

(Reuters Health) – Medical experts recommend that people who have difficulty falling asleep and staying asleep seek advice from a doctor and avoid long-term use of sleeping pills.

A good resource for sleep and a specific type of speech therapy can help people adopt good bedtime habits and understand why they are not sleeping well, according to a new resource for patients published in JAMA Internal Medicine.

Recent research has shown that the use of sleeping pills is widespread and that medications are linked to serious side effects, such as falls and death, said Dr. Michael Incze of the University of California in San Francisco, co-author of the primer page.

In 2017, the American Academy of Sleep Medicine recommended a form of psychological counseling called Cognitive Behavioral Therapy (CBT) as the first treatment for insomnia, followed by prescription and over-the-counter medications. CBT focuses on identifying patterns of thinking and behavior that prevent good sleep.

About 10% of Americans suffer from chronic insomnia and about 30% experience temporary symptoms.

People who often take medication for sleep "should feel encouraged to consult their doctor to find out why they may have insomnia," Incze told Reuters Health by phone.

Available free of charge, the new patient page (bit.ly/2x7XgrN) offers practical advice on the diagnosis and treatment of insomnia. It includes a visual scale of treatment options, ranging from "safe and proven to work" at one end to "potentially dangerous" at the other end.

"Safe and proven" includes sleep hygiene, CBT and short-term use of sleeping pills. "Dangerous" includes the combination of sleeping pills with opioids or alcohol, the use of sleeping pills by the elderly and the continued long-term use of sleeping pills.

"It's not always easy to find doctors who are doing CBT for insomnia right now, even in a big city, and insurance does not cover it often," added Incze. "This is where telehealth and mobile applications could come in."

Incze and co-authors recommend starting with good sleep hygiene, that is, creating a peaceful environment for sleeping. This includes going to bed at the same time each night and getting up at the same time each morning. Instead of staying in bed while you're awake, get up and do something relaxing until you're tired enough to fall asleep, they advise. Also avoid alcohol and caffeine and create a dark and quiet environment to sleep with minimal distractions, which means turning off electronic displays and darkening windows.

"We see insomnia every day in various ages and living conditions and this can lead us to consider other issues such as depression, anxiety and drug problems," said the Dr. Ada Stewart, family physician in Columbia, South Carolina involved in the new publication.

Stewart is a member of the board of directors of the American Academy of Family Physicians, which also provides free information on insomnia. (Bit.ly/2x5nnPV)

"Most sleeping pills should only be used for a limited period of time, usually a week or two, and can be addictive and lead to poor results when mixed with alcohol or alcohol." other drugs, "she told Reuters Health by phone.

Side effects may be stronger in older age groups, so these patients need to pay special attention to sleep medications, especially when they mix with other medications, she said. added.

"I like doing a sleep diary with my patients so we can see what they are doing that can impact their sleep," she said. "Once I have a sleep diary in front of me, I can see if the sleep disorder is more serious and if a study on sleep is needed.

Sleep studies include night tests to monitor sleep and look for medical conditions such as obstructive sleep apnea. Conditions such as stress, anxiety and breathing problems can also affect sleep. The amount of sleep required by different people varies at different times in life, but the average is six to eight hours per night.

"More importantly, talk to your doctor about these problems," said Stewart. "Sleep problems are very common and many patients do not think about asking questions about it."

SOURCE: JAMA Internal Medicine bit.ly/2x7XgrN, Online September 10, 2018.