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Sleep disturbance
Central nervous system
Sleep disturbance or insomnia takes many forms and refers to the disruption of normal sleep patterns. In some people, it may be difficulty in falling asleep. In others it may be waking during the night, waking too early or waking feeling not refreshed after a night’s sleep.

Normal sleep is difficult to define as sleep needs can vary from person to person and can vary according to age. For example, the average amount of sleep a newborn baby needs is 16-20 hours each day, an adult needs about 7-8 hours, while someone in their 80s may require as little as 5 hours per day.

Almost everyone experiences sleeping problems at some point in their life. Generally, people tend to have less sleep than is actually needed – on average 60-90 minutes per day less than is ideal.

Sleep is essential to health. It keeps the immune system strong, helps the brain work efficiently and gives the body a chance to repair itself. Serious health problems can result if a person is deprived of sleep.
There are a number of different causes of sleep disturbances, falling mainly into physical and psychological causes.

Physical causes include things such as pain, discomfort, noise, light, changes in working and social patterns or changes in sleeping environment that are sufficiently irritating or different to prevent the person falling asleep or to cause the person wake after falling asleep.

Psychological causes include stress, anxiety, worry, fear or bereavement. These causes tend to keep the brain in an active state, prevent relaxation and so keep the person awake or disturb the quality of sleep.

Certain medicines and stimulants may also cause sleep disturbances. Caffeine present in tea, coffee and cola, illegal drugs such as cocaine, medicines used as appetite suppressants or decongestants all keep the brain and body in a state of arousal and hinder sleep. Withdrawal of medicines used initially to help sleep, may result in what is called rebound insomnia and, for this reason such medicines should not be used for long periods.
The usual symptoms of sleep disturbance include not being able to go to sleep easily, waking in the middle of the night or waking early. Feeling drowsy the next day, an inability to concentrate, poor mental and physical performance are also common. Eventually, if sleep disturbance is prolonged, mental and physical performances deteriorate.
Short-term or transient sleep disturbances may be treated with over-the-counter remedies such as diphenhydramine or promethazine. These two drugs are antihistamines that are normally taken for the relief of hayfever and allergic reactions. However, they also cause drowsiness as a side effect and this is the reason why their packs normally carry a warning not to drive or operate machinery if affected. In the case of sleep disturbance, the side effect of drowsiness has the beneficial effect of helping sleep. The warning not to drive or operate machinery should still be accepted and care must be taken to ensure that the medicines are not taken too late at night to have an effect that lasts into the next day.

If sleep disturbance is occurring to such an extent that it prevents the person from performing normal daily activities, it may be treated with sleeping tablets, also known as hypnotics. There are two main types of hypnotic available on prescription, the benzodiazepines and the non-benzodiazepines.

Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or causing the patient extreme distress. The benzodiazepines include the short acting agents loprazolam, lormetazepam and temazepam, and the longer acting agents flurazepam and nitrazepam. The effect of the short acting agents wears off before the end of the night and they therefore tend to have no lasting effect the next morning, allowing the person to wake feeling refreshed. However, short acting benzodiazepines are likely to cause rebound insomnia when treatment is stopped after being taken for some time.

The effect of the long acting agents may last into the next day which may be beneficial if anxiety is a cause of the insomnia, but it can interfere with mental and physical performance. Long acting agents are less likely to cause rebound insomnia than short acting agents.

The principal non-benzodiazepine hypnotics include zaleplon, zolpidem and zopiclone. All have a short duration of action and tend not to produce hangover effects.

For people aged 55 or over, medicines containing melatonin may be used for the short-term treatment of insomnia characterised by poor quality of sleep. Melatonin is a naturally occurring hormone produced by the pineal gland in the brain. Normally, the hormone is secreted as darkness falls and it helps to induce sleep. As people age, the production of melatonin declines and this may be the cause of sleep disturbance. Tablets containing melatonin may help restore this decline and normal sleep patterns.
When to see your pharmacist

Herbal and over-the-counter remedies for the short term relief of sleep disturbances are available from your community pharmacy without the need for a prescription. When purchasing such products it is important that you talk to the pharmacist to say who the medicines are for, whether the person has any other illnesses, is taking other medicine or could be pregnant, and how long the sleep disturbance has lasted. If your pharmacist thinks that these products are inappropriate, you will be advised to see your doctor.

If there is any information you need or if you are unsure about medicines your doctor may have prescribed for insomnia, talk to your pharmacist for advice and guidance.

When to see your doctor

See you doctor if your insomnia continues even after trying out some healthy tips and/or over-the-counter remedies. It could be a sign of your having another illness.

Living with sleep disturbances

Often, some simple changes in lifestyle are all that are needed to restore normal sleep patterns. Try to establish a regular night-time routine by relaxing in the evening and going to bed at the same time each night.

Avoid eating and drinking excessively late at night, especially avoid drinks such as tea, coffee or cola that contain caffeine which is a stimulant. Take regular exercise during the day, avoid napping in the afternoon and falling asleep in front of the television in the evening.

If it is stress at work or in the home that is keeping you awake, try to resolve the problem by talking with those involved. Counselling or cognitive behavioural therapy may be required to help you come to terms with particularly stressful lifetime events.

If lifestyle changes do not work fully, some herbal remedies, for example those containing valerian, passiflora or wild lettuce may help. Certain essential oils such as lavender dabbed onto the pillow are also beneficial. All of these preparations are available from your local pharmacy.

If you need to take medicines, whether they are herbal remedies, over-the-counter remedies or prescription products, remember that they are for temporary sleep disturbances and should only be used for a short time until your body gets itself into a pattern for sleep. If you take these medicines regularly you may start depending on them, making it harder to return to your normal pattern of sleep.

Useful Tips
  • Keep your sleep pattern regular

  • Make sure your bedroom is restful, quiet, as dark as possible and at the right temperature

  • Read or listen to restful music in the hours before you go to bed

  • Don’t eat a heavy meal before going to bed

  • Avoid alcohol before bedtime

  • Exercise regularly – this can relieve the stresses of the day

  • Avoid stimulants like coffee, tea and tobacco – try a hot milky drink instead

  • If you can’t sleep get up and do something

  • Invest in a good bed – you spend a third of each day in bed

Further information

The Sleep Council’s website provides useful advice on beds and tips on how to get a good night’s sleep.

The Sleep Council
High Corn Mill
Chapel Hill
North Yorkshire
BD23 1NL
Freephone: 0800 018 7923

Reviewed on 27 June 2011