March 2013 Insomnia

Health Education

ISSN: 0965-4283

Article publication date: 21 June 2013

287

Citation

(2013), "March 2013 Insomnia", Health Education, Vol. 113 No. 4. https://doi.org/10.1108/he.2013.142113daa.001

Publisher

:

Emerald Group Publishing Limited

Copyright © 2013, Emerald Group Publishing Limited


March 2013 Insomnia

Article Type: Internet review From: Health Education, Volume 113, Issue 4.

Famously, Margaret Thatcher, the ex-British Prime Minister, managed on only four hours sleep per night. Indeed she claimed she thrived on this because it gave her more time for the affairs of state. However, for most people, this amount of sleep would not be enough and it would probably have a negative impact on personal, social and work life activities. The symptoms of insomnia include not being able to fall asleep, waking in the night, waking up early in the morning, feeling tired and irritable and having difficulty concentrating during the day. Not the most terrible of symptoms compared with other conditions, but insomnia is also linked to more serious health problems, for example, anxiety and depression, heart disease and diabetes, so indirectly, insomnia could be a killer. There are many different “treatments” on offer to people who suffer from insomnia, some legitimate, others more exotic. In this review we will compare web sites that promote different ways of dealing with insomnia, evaluating the value of the web site as well as the efficacy of the treatment offered.

NHS choices

www.nhs.uk/Conditions/Insomnia/Pages/Introduction.aspx

The home page for insomnia on this web site provides an overview of the condition describing the common symptoms and very briefly, giving some self-help advice, as well as guidance on when to seek help from the doctor. There is also a video clip in which a sufferer describes her symptoms and an expert explains how to minimise the symptoms. The rest of the web site then goes on to provide much more detailed information on these broad areas. The section on symptoms deals with the issue of how much sleep we actually need (it varies!) and it also advises on how to keep a sleep diary, very useful if you do need to see a doctor. One of the more difficult items to deal with is the cause of insomnia. This is because there is no single cause, it is multifaceted, with causes ranging from stress to different types of physical or mental illness and it also includes the side effects of medicines prescribed for these illnesses. Attached to the home page is a section on medicines for insomnia and this lists more than two dozen remedies including those that can be bought without a prescription, for example Jamaica Dogwood as well as the more conventional pharmaceuticals like Mogadon. For each of the remedies listed a free downloadable guide is provided explaining what the remedy is, how it works and possible side effects. There is also guidance on who should not be using the particular remedy. The section on diagnosis is simply a reiteration on the value of keeping a sleep diary and how your doctor may be able to help. Under the heading on Treatments further advice is provided on pharmaceutical and herbal medicines and there is a useful section on how cognitive behavioural therapy (CBT) might be able to help. Finally, the section dealing with self-help provides advice on daytime and bedroom habits. Basically this says get up at a regular time, take exercise, do not nap and only use the bedroom for sleeping or sex! Sound advice from a well-designed web site that provides just the right level of information for the lay user.

British Acupuncture Council

www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/insomnia.html

Acupuncture is one of the few complementary therapies that is recommended for certain conditions by National Institute of Clinical Excellence (NICE) in the UK. The evidence for the effectiveness of acupuncture has been confirmed in the case of lower back pain, dental pain and certain kinds of post-operative nausea. There is no evidence for the use of acupuncture for weight loss or smoking cessation and as far as other conditions including insomnia are concerned, further studies are required.

This web site, of the British Acupuncture Council, begins with some basic data on insomnia on the extent of the problem and points out that in the UK some 10 million prescriptions for hypnotics, i.e. sleeping pills, are dispensed each year. Around 80 percent of these prescriptions are for people over 65 years and many patients remain on these drugs for months or even years, despite the dangers and the hazards to health that this poses. The implication of course is that acupuncture may be a safer alternative to drug-induced sleep. Clicking on the next page provides readers with a very brief introduction to acupuncture, but in one or two paragraphs it seems doubtful that users will really grasp what acupuncture can do. From a health education perspective the final section which provides “evidence” for the efficacy of acupuncture in treating insomnia will be the most interesting to many professional users of this web site. Unfortunately the very first paper cited as evidence for the efficacy of acupuncture is a systematic review that looked at 20 randomised clinical trials, came to the conclusion that of these only four were of high quality, and of these, none of them could confirm the efficacy of acupuncture in relieving insomnia. Not a good start! However, many other studies are cited and several are in respected journals. The overall conclusion is probably that there does appear to be some evidence for the efficacy of acupuncture in treating the symptoms of insomnia when compared with drug treatments, placebos and sham acupuncture. However, before a wholesale recommendation can be made, more research is required.

MindBodyGreen

www.mindbodygreen.com/0-5104/Herbs-for-Insomnia.html

The MindBodyGreen web site is a generic site dealing with many facets of life that might impact on health and well-being. This includes guides dealing with different types of yoga, dietary advice, travel directories and, of course, specific conditions such as insomnia. The first thing of interest in this web site as far as insomnia is concerned is the distinction drawn between evening and morning insomnia. As the names suggest, evening insomnia is concerned with difficulty in falling asleep initially whereas morning insomnia is about waking in the early hours and not being able to get back to sleep. The implication is that these are two different conditions and therefore will require different treatments and indeed this is reflected in the herbal recommendations made. It is also interesting that other web sites dealing with insomnia do not make this distinction. What then follows is a description of various types of herbs that are recommended for the different types of insomnia. For evening insomnia, Valerian, California Poppy, Passion Flower or Hops are all suggested. For each herb a brief description on dosage is provided and its likely effects. Where necessary, warnings are provided for vulnerable groups, for example pregnant or nursing women, children, or people with kidney problems. Similarly for evening insomnia, a different set of herbal remedies are recommended.

While these herbal remedies probably will not do any harm, their efficacy in dealing with insomnia remains to be tested. The web site does not provide details of any corroborating research but that is to be expected with this type of web site. Other advice that is also provided is probably is more efficacious than the herbal remedies. These include exercising for 20 minutes two hours before bedtime, having a warm bath 90 minutes before retiring and cutting back on sleeping pills. Undoubtedly these remedies will work for some people some of the time but whether that is because they do have some unknown medicinal value, or whether it is simply a placebo effect, remains to be seen.

Insomnia-Free

www.insomnia-free.com/cbt-insomnia.html

This is one of those web sites that has been created by an enthusiastic amateur who has suffered from the particular condition and now want to help others. Although this type of web site might lack some of the more dynamic flair of professionally produced web sites they often can make up for this through the first-hand knowledge of the web site owners. While this web site does provide a great deal of information and insight into insomnia, the focus of the review is on what it has to say about CBT for dealing with the symptoms of insomnia.

The first thing to note about this web site is that if you click on the CBT link then you are taken to the part of the site that provides information on CBT and how it can be used to deal with insomnia. However, if you are already in the site and you click on the link to CBT under the Insomnia Help pull-down menu, then you will be taken to a different part of the web site that is only slightly related to CBT; the content needs better organization.

From a self-help perspective this web site has the right approach in that it attempts to teach people how to use CBT for themselves to help with the symptoms of insomnia. However, the extent to which is achieves this desirable aim is debatable. For example, the first thing users are asked to do as part of this CBT programme is to “First, identify what we are thinking” and it suggests this can be done by writing down our thoughts on paper. But it doesn’t explain what thoughts. Is it only those that keep us awake at night or just any random thoughts? It then continues in this way with extremely vague instructions that are more reminiscent of “pop-psychology” rather than CBT. There is an accompanying CBT tutorial with this programme and that is actually much better. The advice and guidance offered here is much more practical and will be of benefit for people who suffer from the symptoms of insomnia.

As usual with this type of web site, the user is plagued with intrusive advertisements that bear no relevance to the subject matter of the web site but this is something the user has to accept if they want to make use of the content. As an introduction to CBT for insomnia this web site is a good start but users should keep in mind the fact that the designer and owner of this web site has no professional qualifications in the field of insomnia and therefore any recommendations made should be treated cautiously.

Peter Eachus

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