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 Good sleep hygiene and a specific kind of talk therapy may help
people create good bedtime habits and figure out why they're not
sleeping well, the experts say in a new resource for patients
published in JAMA Internal Medicine.
Recent research has shown that use of sleeping pills is very common
and that the drugs are linked with serious side effects, such as
falls and death, said Dr. Michael Incze of the University of
California, San Francisco, who co-wrote the one-page primer.
In 2017, the American Academy of Sleep Medicine recommended a form
of psychological counseling called cognitive behavioral therapy (CBT)
as a first treatment for insomnia, followed by prescription and over
the-counter medicines. CBT focuses on identifying patterns of
thinking and behavior that prevent good sleep.
About 10 percent of Americans experience chronic insomnia, and about
30 percent have temporary symptoms.
People who often take sleep medicine "should feel encouraged to talk
to their doctor about looking deeper into why they may be having
insomnia," Incze told Reuters Health by phone.
Available for free, the new patient page (http://bit.ly/2x7XgrN)
offers practical tips about insomnia diagnosis and treatment. It
includes a visual scale of therapy options, ranging from "safe and
proven to work" on one end to "potentially dangerous" on the other
end.
"Safe and proven" includes sleep hygiene, CBT and short-term use of
sleeping pills. "Dangerous" includes combining sleeping pills with
opioids or alcohol, use of sleeping pills by older adults and
continuous long-term use of sleeping pills.
"It's not always easy to find doctors who do CBT for insomnia right
now, even in a big city, and insurance doesn't often cover it,"
Incze added. "That's where telehealth and mobile apps could come
in."
Incze and co-authors recommend starting with good sleep hygiene,
that is, creating a peaceful environment for sleep. This includes
going to bed at the same time every night and getting up at the same
time every morning. Instead of staying in bed lying awake, get up
and do something relaxing until you're tired enough to fall asleep,
they advise. Also, avoid alcohol and caffeine, and create a dark,
quiet environment for sleeping with minimal distractions, which
means turning off screens on electronic devices and darkening
windows.
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"We see insomnia every day in various ages and walks of life, and it
can lead us to consider other concerns such as depression, anxiety
and medication issues," said Dr. Ada Stewart, a family physician in
Columbia, South Carolina who was not involved with the new
publication.
Stewart is a member of the Board of Directors of the American
Academy of Family Physicians, which also provides free information
about insomnia. (http://bit.ly/2x5nnPV)
"Most sleeping medicines should only be used for a limited amount of
time, usually a week or two, and can be addictive and lead to bad
outcomes when mixed with alcohol or other drugs," she told Reuters
Health by phone.
Side effects can be stronger in older age groups, so these patients
should be particularly careful about sleep medicines, especially if
mixing with other prescriptions, she added.
"I like doing a sleep diary with my patients so we can look at what
they're doing that can impact the way they're sleeping," she said.
"Once I have a sleep diary in front of me, I can see whether it's a
more serious sleep disorder and whether they need a sleep study."
Sleep studies include overnight tests to monitor sleep and look for
medical conditions such as obstructive sleep apnea. Conditions such
as stress, anxiety and breathing issues can also affect sleep. The
amount of sleep required by different people varies at different
points in life, but the average is six to eight hours per night.
"Most importantly, talk to your doctor about these concerns,"
Stewart said. "Sleep issues are very common, and many patients don't
think to ask questions about it."
SOURCE: http://bit.ly/2x7XgrN JAMA Internal Medicine, online
September 10, 2018.
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