Insomnia in 60 Seconds

Sleep disturbance and daytime fatigue, can cause distress and impairment of daytime functioning, leading to a reduced quality of life. Insomnia is a risk factor for certain mental conditions and possibly a warning sign for serious mental or medical issues.

Estimates of prevalence vary, but research in the UK has indicated that insomnia is thought to affect about one third of the general population with about 75% of patients reporting symptoms lasting at least a year.

Older age is associated with poorer sleep with shorter sleep time, diminished sleep efficiency, and more arousals.

The diagnosis of insomnia is primarily based on patient-derived and family or caregiver complaints, as determined by a clinical interview with a patient diary. Ask a patient about daytime functioning to establish the diagnosis.

Up to 80% of insomnia is associated with a comorbidity. Early identification and management of any comorbid disorders is essential.

Non-pharmacological interventions are established as first-line therapy in the management of primary insomnia. Sleep hygiene, sleep consolidation, stimulus control, relaxation therapy and cognitive behavioural therapy (CBT) have been demonstrated to be as effective as pharmacotherapy.

Should non-pharmacological approaches prove ineffective then a hypnotic medication may be considered appropriate for the management of severe insomnia interfering with normal daily life.

There is good evidence for the efficacy of traditional hypnotic drugs (benzodiazepines / Z-drugs) in short-term insomnia. However, their use is associated with adverse effects, such as daytime sedation, poor motor coordination, cognitive impairment, and related concerns about driving accidents and injuries from falls. These safety concerns are particularly worrying in the elderly population. The lowest dose that controls symptoms should be used, for a maximum of 4 weeks and intermittently if possible.

For patients over 55 years of age with persistent insomnia, treatment with a prolonged-released melatonin should be considered.

Circadin® (prolonged-release melatonin 2mg tablet) is the only licenced formulation of melatonin in the UK. The licensed product, rather than unlicensed alternatives, should be used wherever possible.