Insomnia

Insomnia — an isolated sleep difficulty — is a very common problem. It tends to be recurring, though rarely persistent; which may explain the limited number of people seeking help. Doctors often refer to it as a “primary” problem, as distinct from sleep disturbances caused by other conditions, such as depression or anxiety.

Historically patients were advised to maintain “sleep hygiene”; unfortunately some of the recommended measures have since been shown to be counter-productive.

The most effective modern treatment for primary insomnia is cognitive-behavioural therapy for insomnia (CBT-i). This is a protocolised variant of CBT that can either be completed with a therapist (in person or over Telehealth); or online/at home (iCBT-i). Your GP can refer to you to a current academic trial from Flinders University.

Although less recommended, there are some relevant pharmaceuticals. The most commonly used benzodiazepines and derivatives are highly problematic; not restoring sleep architecture while quickly generating dependence.

Lemborexant (“Dayvigo”) was recently approved and became available locally. It is the second orexin antagonist, perhaps finally fulfilling the promise of the drug class after the largely unimpressive suvorexant (“Belsomra”). The published data is rather remarkable, being effective while not suggesting development of dependence.

Melatonin is our natural sleep hormone, rising after sunset, resulting in sleep drive. Supplementation is most effective in those with shift work, jet lag, or a delayed sleep phase (“night owl”). For insomnia, older adults in particular also seem to respond well, thus it is now available over the counter for that age group. It may also benefit select younger adults, though requiring a prescription.

Finally, there is some evidence magnesium supplementation can help.