Information
Insomnia is the term used to describe inadequate or poor-quality sleep which may be due to one or more of the following: difficulty falling asleep; difficulty staying asleep; waking up too early in the morning and non-refreshing sleep.
How does insomnia affect daytime function?
Insomnia results in unrefreshing sleep and can lead to daytime problems of tiredness, lack of energy, difficulty concentrating and irritability.
Are there different types of insomnia?
Periods of sleep difficulty lasting between one night and a few weeks are referred to as acute (short-term) insomnia.
Chronic insomnia refers to sleep difficulty at least three nights a week for one month or more. Most people with chronic insomnia will NOT be excessively sleepy.
Rule of thumb:
- Sleep-onset insomnia is most commonly associated with anxiety. Ensure that a severe delayed sleep phase syndrome (DSPS) is excluded. Circadian rhythm disorders – RefHelp Also ensure that sleep hygiene is enforced.
- Middle insomnia is generally related to medical issues and illness, including pain, alcohol withdrawal etc.
- Late insomnia (sometimes also early morning wakening) is often related to depression.
For more information on see Insomnia Further Information
The Department of Sleep Medicine is not funded to manage insomnia.
If specialist advice is called for, please write a short referral letter to the department via sci-gateway (see under whom to refer)
Please ensure underlying or co-morbid conditions are identified, treated and referred on where necessary.
Who can refer:
Any healthcare professional seeking advice only where the guidelines cited below have been exhausted.
Who to refer:
For advice only, for extreme cases, advice can be sought by sending a referral letter via Sci-Gateway
Refer to appropriate service depending on what is causing the insomnia if it is not easily managed in primary care, e.g. psychiatric services for severe anxiety/depression, cognitive behavioural therapy, pain service.
Who not to refer:
Do not refer insomnia to the Department of Sleep Medicine.
If a circadian rhythm disorder is suspected e.g. extreme phase delay, then you are welcome to seek further advice on management after the patient has completed a sleep diary for at least one month.
How to refer:
RIE > Respiratory Sleep > LI Sleep Referral.
Acute insomnia can be treated with short-term use of sedative medications. There is some evidence to support no treatment for very limited episodes of insomnia.
Good sleep hygiene is important.
Address the underlying cause: pain, anxiety, jetlag, acute illness etc.
Chronic insomnia should generally be managed using a combination of treatments. These treatments include the use of relaxation techniques; associating the sleeping environment with sleep only; establishing a regular sleep pattern; environmental change; assessing the use of caffeinated beverages, drugs, alcohol and smoking addiction (do they get up and smoke during the night?) treatment of medical and mood problems and judicious use of medication. Is the bedroom environment safe?
People with chronic insomnia may benefit from counselling or cognitive behavioural therapy for anxiety or specifically cognitive behavioural therapy for insomnia. There are several private practitioners within Edinburgh and the Lothian area who can provide this and some GP practices have an interested health practitioner who can provide assistance.
Not all of the treatments will apply to or be effective in every individual with insomnia.
Makes sure that you have excluded an organic sleep disorder such as severe sleep apnoea, restless legs syndrome or a circadian rhythm disorder (use a four-week diary to do this).
The Sleepio App, is an NHS endorsed app that uses CBT for insomnia. This can be useful for some patients as a first line measure. It is very important patients use this during the day rather than at night.
Management | Insomnia | CKS | NICE
Cognitive Behavioral Therapy for Insomnia (CBT-I): An Overview
– includes links to practitioners in Scotland and the UK overall.
