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Lifestyle advice

Prevention
There are some simple measures you can suggest to patients to help prevent insomnia, including:[1,5,6,10,11] 

  • Avoid caffeine and nicotine six hours before bedtime
  • Do not drink alcohol around bedtime
  • Avoid heavy meals before bedtime
  • Regular daily exercise is advisable but shouldn’t be carried out within four hours of bedtime
  • Take steps to establish a routine pattern of daytime wakefulness and night time sleepiness which will train the body to sleep at night.For example:
     - avoid daytime naps,
     - only go to bed when feeling sleepy 
     - get up at the same time seven days a week regardless of the amount of sleep obtained and
     - avoid lie-ins or using the weekends to catch up on sleep
  • Ensure the bedroom environment encourages sleep
    -  Minimise noise, light and excessive heat at night
    -  Ensure the mattress and pillow are comfortable
  • Avoid using the bedroom for non-sleep activities such as work, reading or television
  • Stop ‘clock watching’
  • Try to create a routine such as a warm bath or milky drink every night - these activities then become associated with sleep and will trigger drowsiness.

     

    <PRACTICE POINT>
    What lifestyle advice would you give to the following people who are all suffering from insomnia:

    An elderly lady who has just moved into the area after the death of her husband. A woman who works full time and looks after her four children. She never stops!A man who does shift work.


    Management
    In managing insomnia when it actually happens, advise patients to follow the 30 minute rule. If it takes longer than 20 to 30 minutes to fall asleep, they should get up and go into another room for a short period.[5] They should do something distracting, such as reading or watching television, then return to bed when they feel sleepy.[5] This technique should be repeated as often as necessary until they fall sleep.[5] When anxiety or worry is keeping someone awake, writing down a list of problems and ideas on how to solve them can help them put these issues to one side until morning.[1]

    Other approaches to managing insomnia include relaxation techniques, such as deep breathing, and exercise.[5,6] Evidence has shown that doing moderate exercise for 30 minutes four times a week improves chronic insomnia in older adults.[12,13]