opinion: rethinking pills and the insomnia epidemic

if the health impacts of covid-19 weren’t already enough, you can now add  a quietly brewing insomnia epidemic  to the daily disruptions the pandemic has brought to our lives.

immediately turning to sleeping pills, however, is not the right answer. a recent  international assessment of sleep disturbances  during the pandemic found a greater than 20 per cent increase in sleeping pill usage, highlighting not only increased insomnia but also a reliance on easily accessible therapy. sleeping pills come with their own host of side effects: dependence, memory loss and unsteadiness, and therefore cannot be taken lightly.

sleep hygiene

for most people without underlying causes of insomnia,  lifestyle modifications to improve  sleep hygiene and cognitive behavioural therapies are the first-line approach . it may be helpful to define a specific workspace outside your bedroom and create structured start and stop times for work, much like one would have if working at an office. this can help you establish a consistent sleep regimen, to improve not just the quantity of sleep but also the quality.

while lifestyle modifications are helpful ways to combat sleep cycle disturbance, in some instances, these specific modifications may not be an option. take, for example, front-line healthcare workers or shift workers who are working extended hours to provide much-needed care to those who need it. humans are naturally diurnal and working through the night can seriously impair sleep health and functioning. to help with this,  experts recommend  trying a short nap before a night shift and exposure to natural daylight the following day. furthermore, the inability to eat meals at routine intervals or consuming substances that may interfere with sleep such as coffee, tea, and colas often contribute to impaired sleep health. sleep environment is another such contributor, where daytime noise and disruptions, not having a cool and dark environment prevent one’s ability to obtain quality sleep.

medication for insomnia and poor sleep

for some patients,  pharmacological measures can be beneficial  in obtaining immediate relief. despite their demonstrated effectiveness, most agents are not intended for long-term use. in particular, benzodiazepines and other hypnotic drugs such as zopiclone and zolpidem, are known for the risk of dependency and withdrawal effects, especially at higher doses. for this reason, they are often prescribed for a length of therapy of 1 to 2 weeks.

as insomnia becomes more prevalent, novel therapies continue to emerge, providing patients more options for treatment. one relatively new agent,  lemborexant , may be safer for long-term use as clinical trials suggest an  absence  of dependency and withdrawal effects. although its mechanism of action differs from benzodiazepines and hypnotics, patients taking this drug should also avoid concurrent alcohol consumption and be aware of side effects such as headache and drowsiness.

10 tips to improving sleep hygiene

-40 minutes or more of sweat-inducing exercise during the day can help you get more restful sleep. however, try to avoid intensive exercises in the evenings.
-avoid taking extensive naps or sleeping in, as these activities may make that night’s sleep more challenging.
-try to use the bedroom solely for rest and intimacy to avoid associations with work or other waking activities.

-avoid large meals right before bed
-avoid nicotine, recreational drugs, caffeine, and alcohol – if smoking is a must, try not to do so within 4-6 hours of bedtime.
-minimize screen time by removing electronic devices such as tvs, computers, and smart phones from the bedroom. -if you must be near a phone, try placing it outside of arm’s reach from the bed, perhaps on a nearby shelf.

-ensure your bedroom is quiet and comfortable – try to invest in a good mattress and pillow. use eye masks and earplugs if you live in a loud environment. blackout curtains can be helpful when living in a busy city.
-try to keep a routine where you go to bed and get up at the same time each day. your body can learn a pattern in as little as 1 week.
-avoid watching the clock as you try to sleep as this can reinforce sleep anxiety.
-if you cannot fall asleep within 20 minutes, get up and try to do something calming until you feel sleepy.