My sleep is terrible — do I need medication?

Hold on: first we have to remember that insomnia can come on its own, it can be a symptom or it can be associated with another condition. And that, for insomnia itself, we should start by looking at behaviour.

Behaviour is something you work on

Medication can make you sleep, and it can be a great ally when it is really needed — but it is not the first treatment: the first is CBT-I, cognitive behavioural therapy for insomnia.

And don't tell me you already do everything sleep hygiene tells you to. Believe me, there is still behaviour and beliefs to uncover that get in the way of your sleep.

«Sleeping badly tonight will harm me tomorrow.» It is a common belief — and it makes sense, who doesn't think that after a bad night?

But that is where it turns against you. To avoid repeating the awful night, you go to bed earlier, before sleep arrives, and start monitoring every minute. Sleep, the most automatic thing in the world, becomes a task.

And a task gets chased, measured, forced. By trying so hard to control sleep, we get in the way of the very thing we wanted. Sleep hygiene is the beginning, not the whole treatment.

Looking at what comes with it

Anxiety, menopause, hyperthyroidism, sleep apnoea can have insomnia as a symptom or be associated with it. That is why it is always worth looking at what comes with it.

Because when one thing is influencing the other, the treatment has to address both.

And please don't self-diagnose: recognising a sign is not closing a diagnosis.

Before changing habits

In the end, a doctor you trust will be essential — because before moving on to changes or treatments, you need to understand what is happening to you.

References

Qaseem A, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125-133. pubmed.ncbi.nlm.nih.gov/27136449

Brasure M, et al. Psychological and behavioral interventions for managing insomnia disorder: an evidence report for a clinical practice guideline. Ann Intern Med. 2016;165(2):113-124. pubmed.ncbi.nlm.nih.gov/27136619

Espie CA, et al. The attention-intention-effort pathway in the development of psychophysiologic insomnia: a theoretical review. Sleep Med Rev. 2006;10(4):215-245. pubmed.ncbi.nlm.nih.gov/16809056

Irish LA, et al. The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev. 2015;22:23-36. pubmed.ncbi.nlm.nih.gov/25454674

Morin CM, Vallières A, Ivers H. Dysfunctional beliefs and attitudes about sleep (DBAS): validation of a brief version (DBAS-16). Sleep. 2007;30(11):1547-1554. pubmed.ncbi.nlm.nih.gov/18041487

Dra. Clarice D. de Araujo · Psychiatrist · CRM-DF 12141 · RQE 5862