What practical help can the physicians offer to people who say they cannot sleep? A useful 10 minute consultation article in the BMJ suggests the following:
* Rule out causes of insomnia such as depression, anxiety, sleep apnoea, pain, daytime naps, evening caffeine intake or exercise
* Ask patients to keep a sleep diary and note how many hours they spend in bed and how many asleep
* Calculate sleep efficiency ((hours asleep/hours in bed)x100): 80-85% is optimum, <75% indicates poor quality sleep, >90% may indicate sleep deprivation
* Advise sleep restriction. Restrict time spent in bed to time spent asleep – thus, if sleeping only 6 hours, spend just 6 hours in bed
* After two weeks, gradually increase the time spent in bed, but reduce this again if quality of sleep declines.
Source: The Daily Star, December 27, 2008
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