Insomnia

The causes of insomnia can be complex, including:

• Psychological Factors: Stress, anxiety, and depression
• Lifestyle Choices: Alcohol, caffeine, or nicotine use, especially close to bedtime
• Environmental Factors: Noise, light, or an uncomfortable sleep environment
• Medical Conditions: Chronic pain, asthma, gastrointestinal issues
• Medication Side Effects: Certain medications may interfere with sleep

Symptoms of insomnia include:

• Difficulty falling asleep
• Waking up during the night
• Waking up too early
• Not feeling rested after sleep
• Daytime fatigue or sleepiness
• Irritability, depression, or anxiety
• Difficulty paying attention or focusing

In Australia and around the world:

• Benzodiazepines: Temazepam (Restoril), Nitrazepam (Mogadon)
• Non-Benzodiazepine Hypnotics: Zolpidem (Ambien), Eszopiclone (Lunesta)
• Antidepressants: Trazodone (used off-label for insomnia)
• Melatonin Receptor Agonists: Ramelteon (Rozerem)

• Benzodiazepines: Dependency, dizziness, memory problems
• Non-Benzodiazepine Hypnotics: Sleepwalking, memory loss, daytime drowsiness
• Antidepressants: Dry mouth, constipation, urinary retention
• Melatonin Receptor Agonists: Dizziness, nausea, fatigue

It's estimated that around one-third of the adult population globally experiences some form of insomnia. 

In Australia, approximately 13-33% of the adult population is affected by insomnia to some extent.

• Cognitive-Behavioral Therapy for Insomnia (CBT-I): Considered the gold standard treatment.
  • Reference: Morin CM, et al. Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004). Sleep. 2006.
• Mindfulness and Relaxation Techniques: Including meditation and deep breathing exercises.
  • Reference: Gong H, et al. Mindfulness meditation for insomnia: A meta-analysis of randomized controlled trials. Journal of Psychosomatic Research. 2016.
• Herbal Remedies: Such as valerian root and lavender, though evidence is mixed.
  • Reference: Bent S, et al. Valerian for sleep: A systematic review and meta-analysis. The American Journal of Medicine. 2006.
• Sleep Hygiene Practices: Including regular sleep schedule, appropriate sleep environment.
  • Reference: Irish LA, et al. The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Medicine Reviews. 2015.

De-prescribing in insomnia often involves transitioning from sleep medications to non-pharmacological strategies, ideally under the guidance of healthcare providers.

• CBT-I in Medication Discontinuation: Several studies have supported using CBT-I for de-prescribing sleep medications.
  • Reference: Smith MT, et al. Use of behavioral treatment for chronic insomnia comorbid with medical or psychiatric conditions. Sleep Medicine. 2008. Link
• Tapering Programs: Gradual reduction of medication while implementing behavioral strategies.
  • Reference: Baillargeon L, et al. Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: A randomised trial. CMAJ. 2003. Link

Treating insomnia requires a multifaceted approach, and de-prescribing medications often necessitates replacing them with effective non-pharmacological strategies. Collaboration with healthcare providers skilled in sleep disorders is crucial for successful treatment.