General management and advice to patient and family

(ref 218-220)

• Encourage the patient to practise good sleep hygiene:
  - Keep to regular hours for going to bed and getting up in the morning, including at weekends
  - Make plans or think about problems before retiring to bed
  - Keep a pen and pad next to the bed for writing down troublesome thoughts which can then be reviewed
  - Avoid caffeine and alcohol in the evenings
  - Avoid daytime naps.
  
  
• Daytime exercise can help the patient to sleep regularly, but evening exercise may contribute to insomnia.
• Behavioural treatment is safer and more effective than medication (eg cognitive therapy, stimulus control, sleep restriction, relaxation). (see Learning to relax)
• Self-help leaflets, books and groups may be useful. (see Sleep problems)
• Sleep diaries are often useful in assessment and monitoring of progress. (see Sleep problems)

References

218 Kupfer DJ, Reynolds CF. Management of insomnia. N Engl J Med 1997, 336: 341-346.

219 Ancoli-Israel S. Insomnia in the elderly: a review for the primary-care practitioner. Sleep 2000, 23(Suppl 1): S23-S30.

220 Edinger JD, Wohlgemuth WK. The significance and management of persistent primary insomnia: the past, present and future of behavioural insomnia therapies. Sleep Med Rev 1999, 3: 101-118.

Last edited: 26/1/2004

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