Sleep on the NHS

Insomnia is a critical public health issue. Invariably this places a burden on the NHS. There has been a recent rise in research investigating insomnia causes and treatments as clinicians are recognising the significance of adequate sleep on mental health conditions. In fact, most conditions have insomnia as a symptom. Such research has caused a shift in the way diagnoses are now reached.

Sleep Disorder Diagnosis

The DSM-5 and ICD-10 are the diagnostic manuals for mental health disorders. In previous editions, a great deal of emphasis was placed on the symptom causes of sleep problems which a.) Lead to confusions around reaching a diagnosis; and b.) Delayed a diagnosis altogether. There is a great deal of co-morbidity with sleep problems and it is not always easy to tell whether what the trigger is. Some medications for schizophrenia, antidepressants, and epilepsy have insomnia inducing side effects, which then exacerbates the original mental health disorder. Historically, clinicians have been reluctant to prescribe sleeping pills is that they are highly addictive and there is a rapid tolerance rate, which makes overdoes all too easy. However, one thing is clear: when stress and anxiety is reduced, sleep hygiene is improved, and long-term pain is better managed then insomnia improves. In addition, research is showing is that there is a positive correlation between good sleep and improved mental health – which from the NHS’s point of view, relieves some of the burden.

Sleep Research

With the advent of neuroscience research, the medical world is recognising the impact of psychology on physical health which is encouraging greater self-agency. With stress as our modern world epidemic, the public are becoming more informed on their health and lifestyle choices. In my professional opinion, many of the psychological causes of insomnia are connected to the physical and psychological act of letting go. The paradox of sleep is that you need to take control of your thoughts in order to let go of you mind and body to allow yourself to slip into the peace that sleep provides.

Common Sleep Disorders

Common sleep disorders now fall under these main categories making diagnosis easier for clinicians:

1.     Insomnia Disorder - dissatisfaction with sleep quantity or quality

2.     Hypersomnolence Disorder – excessive sleepiness with difficultly waking up and confusion

3.     Narcolepsy – sudden daytime sleepiness and sudden muscle weakness

4.     Breathing-Related Sleep Disorders – (Sleep Apnoea) often due to breathing disturbances

5.     Circadian Rhythm Sleep-Wake Disorders -  misalignment between the endogenous circadian rhythm and the sleep–wake cycle

6.     Parasomnias – abnormal movements, behaviours, emotions, perceptions, and dreams associated with the sleep process. Includes: Non–Rapid Eye Movement Sleep Arousal Disorders, Nightmare Disorder Rapid Eye Movement Sleep Behaviour Disorder, and Restless Legs Syndrome – aches and pains in legs relieved by sudden kicking/ walking

7.     Substance/Medication-Induced Sleep Disorder – sleep disturbances owing to ingested substances like medications, alcohol or illicit substances even tobacco.

How To Treat Insomnia

If you are concerned you have a sleeping problem you need to got to your Doctor who will either refer you to a specialist and/or give you an assessment and a brief questionnaire: Insomnia Severity Index.

  1. A physical examination will rule out physical disorders that mimic Insomnia.

  2. You will then need to complete a Sleep Diary to identify your sleep patterns.

  3. From that point, a personalised treatment plan will be formulated which may involve pharmacotherapy (for short-term use only unless a pathology is identified); and you will be referred for cognitive behaviour therapy for insomnia (CBT-I) - involving sleep hygiene education, which means creating a comfortable sleeping environment (you should change your bed at least every 9 years) and relaxation techniques such as mediation and addressing distorted thinking and creating a healthy sleep ritual.

  4. Though CBT-I is offered on the NHS Cognitive Behavioural Hypnotherapy (CBH-I) is in fact the most effective insomnia treatment. Mindfulness-based cognitive sleep training for Insomnia is also helpful and favoured.

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