“Sleeping tablets are a sticking plaster, not a cure”

According to the NHS Choices website, insomnia is defined as regularly having problems sleeping.  Luckily, although sleep difficulty is problematic if it goes on for a long time, it usually gets better by changing your habits.  It is also really common, with most people experiencing it at some point as a result of physical, psychological or a combination of both.  Our bodies need good quality sleep, but the quantity of sleep a person needs can vary. 

Stress, anxiety and depression are the most common causes for insomnia, but other causes include noise, room temperature (maybe too hot or cold), your bed, shift-work, jet-lag, alcohol, caffeine, nicotine or recreational drugs.  Identifying the most likely cause in your particular case will be the first step to treating the insomnia.

Indeed, insomnia usually does improve if you successfully change your sleeping ‘habits’- and you can read about what to try on page 11 of this magazine. I would strongly advise giving all these a good try before seeking advice from your GP or local pharmacy about other options.

In addition to lifestyle changes, there are a wide variety of ‘non-pharmacological’ options available.  These range from earplugs, noise-cancelling headphones and sleep therapy pillow speakers to devices like Dodow© which uses light to help you fall asleep faster, or air-humidifiers and aromatherapy.  With these working in all sorts of ways, it may be a case of trial and error until you find the one that suits you best.

When to explore sleep medication

In the unfortunate event that these lifestyle suggestions don’t work, and your insomnia has been going on for several weeks, help is available via your local pharmacy in the form of sleeping tablets.  These will not directly address the cause, but lack of sleep will affect your ability to function and cope.  As such they may give short-term relief, but you must be aware of increased drowsiness the next day.  Dependence is a major concern, so I must also be clear that all pharmacists should advise anyone buying sleeping tablets that they are only sold in small packs as a temporary solution. 

If you do find yourself needing to seek advice from your local pharmacist, you should be asked what other medications you take, so go prepared with your repeat prescription list.  Options will comprise of herbal/natural remedies or medications such as Nytol© which cause drowsiness.  In general, agents such as Nytol are likely to be more effective, but I know that some people would prefer to try herbal tablets. 

It is important to bear in mind that many herbal remedies will not have undergone clinical trials and will definitely not have been researched in the context of PH or in patients taking other medications.  They can, however, still interact with some prescribed medicines and alcohol, causing additional drowsiness.  This may be problematic if you plan to work or drive the next day.

The most commonly sold sleep aids such as Nytol contain an antihistamine medicine called diphenhydramine.  It may be cheaper to ask for this by name rather than the brand name (as with paracetamol vs Panadol©).  Older antihistamines, including diphenhydramine and chlorphenamine (also called Piriton©) were developed and found to be very effective for relieving allergic reactions and skin itch.  However, they also cause drowsiness. 

For insomnia, we use the drowsiness as a ‘beneficial side effect’.  A similar example of beneficial side effects familiar to PH patients is sildenafil.  Originally developed as a treatment for high blood pressure and angina, the ‘beneficial side effect’ for men with erectile dysfunction was discovered in early clinical trials. 

In the event that you are still struggling with insomnia despite all of these strategies, your GP may refer you to a therapist.  GPs now only rarely prescribe sleeping tablets (such as zopiclone or zolpidem, not available at the pharmacy counter) for reasons of dependence.  These two medicines are cleaner and more preferable compared to older tablets such as temazepam.  This means they are just as quick to take effect but are cleared from the body more quickly, giving less risk of a ‘hangover’ or drowsiness the next day.

The fact that insomnia is common will not be any consolation if you’re affected.  However, I hope this has given some more background, together with up-to-date NHS advice as to how it can be tackled.  There is undoubtedly much work being done by large companies into products that will help tackle insomnia.  It may seem ironic that the pharmacist article almost steers you away from medicinal solutions, but that is the best advice!  If all else fails, sleeping tablets are a last resort which may help you put in place some healthier sleep habits. But they are a sticking plaster, not a cure.