Triggers
Medication Stepladder
Lifestyle
Difficulty sleeping is a common problem and in many people it is shortlived and resolves. Age alters the sleep pattern and reduces the duration of sleep in many people
Triggers
The duration and exact pattern of the sleep can give clues on what may be making sleep more difficult. Look for pressures at home and work. Life changing events, stress and depression can precipitate sleep problems
Medication Stepladder
Many people manage without medications and either accept they have less sleep or alter their daily pattern to help improve sleep
Antihistamines, antidepressants, and benzodiapine type medications can help and sit in a stepladder order related to side effects. No medication is perfect especially if there are underlying factors such as stress.
Antihistamines have the least side effects and are are the safest. Chlorphenamine (eg piriton) and Diphenhydramine (1-3 tablets of 25mg eg nytol) can be used. They help take the edge off poor sleep.
Antidepressants are especially useful for sleep when low mood or anxiety is a factor. Amitriptyline at the lowest dose of 10mg can be effective. It also helps to improve loose bowel, irritable bowel, and night time urine frequency. However it can make you sleepy the next morning as well as cause constipation.
Dothiepin (25-75mg egProthiaden) can make you less sleepy in the morning than amitriptyline. Mirtazipine (15-30mg) often helps with sleep but can make people very drowsy all day
Benzodiazipines and Z drugs (zlopiclone and zolpidem) have side effects that need to be documented as discussed. These are addiction (withdrawl symptoms when stopped) , tolerance (body gets ued to them) and hangover (more risks of accident the next day). These risks often outweigh the benefits and people have regreted starting them so the advise is to use them only short term except in exceptional circumstances.
Melatonin is a hormone that controls the sleep cycle and is being increasingly used in children as part of management of hyperactivity with specialist supervision. It is early days for this drug and the side effects may yet have to reveal themsleves.
Lifestyle
There are book resources and websites that can give advice including www.patient.co.uk. Avoid things that wake you up in the evenings such as coffee, tea, and late exercise. Try to limit day time naps. Consider regular exercise earlier in the day. Look at work and home stresses and tackle them. If stress and low mood are issues consider advice from an accredited counsellor. And if you tend to naturally sleep less try to consider what might just be the positives of having more time if you sleep less.