What every psychiatrist should know about insomnia

And so on that note of treating insomnia, let's move on to thinking about what we can do for people who have been given a diagnosis.

So if I were to have diagnosed a patient with insomnia in my clinic, could you sketch out the bare bones of how a psychiatrist like myself could approach management?

I think the first thing that we have to do is decide, is this acute or chronic insomnia? Acute is less than three months and chronic is longer than three months.

And to really have a think about if it is acute, is it likely to resolve? Is this an insomnia because the person has just had a recent bereavement, or they're very anxious about a work project that they have to do next week.

In which case, you know, it's going to, it's likely to get better.

And in this situation, because you need a quick fix and you're not going to be needing to do it for a long period of time, medication is often a good intervention.

But if it's become chronic, and usually it has by the time we see our patients, or if you think this doesn't look like it's going to resolve spontaneously at any point, we're then thinking about longer-term treatment.

Now, if these perpetuating factors are psychological, behavioral, and physiological...

It stands to reason that there is going to be a psychological and behavioral intervention, which is cognitive behavior therapy for insomnia or CBTI.

And all the guidelines you look at will tell you that in chronic insomnia, this is the first line treatment.

And it is highly effective.

It's very easy to deliver.

But unfortunately, it's just not available to the majority of people.

If that's not available or it's been tried and hasn't worked for patients, then we may need to think about medication and tackling it perhaps from the more biological perspective.

Although I think I should say that actually CBT for insomnia does also harness the physiological sleep drives.

So it's not just a psychological and behavioral intervention, it's a physical intervention as well.

But there are times when medication is needed.

And then, you know, the decision that we have to make is with any medication, whatever it is, there are potential risks.

But having untreated insomnia comes with risks to the person, to society, to the health care system.

And we need to weigh those up and make a decision about whether we want to treat this.

And my general approach is that because insomnia does have such a huge impact on quality of life, it should never be left untreated.

We should try and tackle it by whatever means we can.