Insomnia
Treating chronic insomnia: investigating the causes, cognitive behavioural therapy â the first-choice treatment â and reviewing medication.
When insomnia becomes a problem
When it's hard to fall asleep, there are repeated wake-ups, or you wake up too early, happening three or more nights a week for at least three months, and it also shows during the day: tiredness, irritability, poor concentration. That's chronic insomnia, and it's one of the most common reasons for a consultation.
What's investigated first
Insomnia is often the tip of something else, which is why the consultation starts by ruling out:
- Sleep apnoea, especially if there's snoring or waking up gasping.
- Restless legs syndrome.
- Anxiety and depression, which go hand in hand with insomnia in both directions.
- Chronic pain, thyroid problems, menopause, medication that keeps you awake.
- Caffeine, alcohol, shift work and irregular schedules.
The first-choice treatment
It isn't medication: it's cognitive behavioural therapy for insomnia. It works on your sleep schedule, the relationship between bed and sleep, the thoughts that come up when you can't sleep, and the behaviours that unintentionally make it worse â staying in bed for hours, long naps, watching the clock. Its results hold once treatment ends, which is exactly what doesn't happen with pills.
And medication
It has its place at specific moments and for a limited time. The problem comes when a two-week course turns into years: tolerance, dependence and sleep that's no longer the same. Coming off those treatments is also done here, gradually and alongside behavioural work, and in coordination with psychiatry or psychology when the case calls for it.
Frequently asked questions
When does insomnia stop being an occasional problem?
When it is hard to fall asleep, there are repeated awakenings or you wake up too early three or more nights a week for at least three months, and on top of that you feel it during the day: fatigue, irritability, poor concentration. That is chronic insomnia and it has a treatment of its own.
Is the treatment sleeping pills?
Not as first line. The treatment of choice is cognitive behavioural therapy for insomnia: sleep schedule, the relationship between bed and sleep, and the behaviours that unwittingly make it worse. Its results are maintained once treatment ends, which is not what happens with pills.
I have been taking sleeping pills for years, can they be withdrawn?
Yes, gradually and accompanied by behavioural work, and in coordination with psychiatry when necessary. It is one of the most frequent reasons for consultation: a course meant for two weeks that has turned into years, with tolerance and sleep that is no longer the same.
What are the 3 types of insomnia?
Sleep-onset insomnia âtrouble falling asleepâ, maintenance insomnia âwaking during the nightâ and early-morning awakening. A distinction is also made between acute insomnia, linked to a specific trigger, and chronic insomnia, which lasts more than three months. Each pattern points to a different cause and a different approach.
What are 5 consequences of insomnia?
Fatigue and daytime sleepiness, irritability and a worse mood, difficulty concentrating and remembering, a higher risk of accidents âincluding at the wheelâ and worsening blood pressure and metabolic control. That is why chronic insomnia is treated, not endured.