What practical help can we offer to people who say they cannot sleep? A useful 10 Minute Consultation article in the BMJ suggests we do the following-
- Rule out causes of insomnia such as depression, anxiety, sleep apnoea, pain, daytime naps, evening caffeine intake or exercise
- Ask patients to keep a sleep diary and note how many hours they spend in bed and how many asleep
- Calculate sleep efficiency ((hours asleep/hours in bed)x100): 80-85% is optimum, <75%>90% may indicate sleep deprivation
- Advise sleep restriction. Restrict time spent in bed to time spent asleep - thus, if sleeping only 6 hours, spend just 6 hours in bed
- After two weeks, gradually increase the time spent in bed, but reduce this again if quality of sleep declines.