How are you sleeping? Effective self-help for insomnia

CBT based self help for Insomnia

There are lots of different self help interventions for insomnia, and it may not be obvious which one to recommend to patients. This is a brief guide to some of them, based on my personal experience of managing my own insomnia. 

I tried a variety of CBT based books, and though they helped a bit, nothing REALLY worked until I used a website called 'Sleepio'.   The key is to follow the sleep restriction programme to the letter. I hadn't done this until I followed the website. Once I did, hey presto. I am now pretty much cured.

There are several CBT based books available which are useful and easily found in bookshops and online. Professor Colin Espie is a world authority on CBT treatment on insomnia and has produced some of the most helpful tools for patients to try. He has written a fairly long and detailed book called 'Overcoming Insomnia and Sleep Problems'  which is aimed at patients. It is an excellent guide for health professionals to read but many patients will find it too long and complicated. He has written a much shorter and accessible book called 'An introduction to coping with Insomnia and Sleep Problems'. These are both based on well researched principles and are very helpful. 

 However I would like to recommend Prof Espie's website www.sleepio.com as perhaps the best intervention. It is a CBT based 6 week course that is superb. It's beautifully designed, with a simple cartoon layout. As I said, the key is to follow the 6 week sleep restriction programme. This seeks to improve sleep efficiency (proportion of time in bed spent asleep). It does require commitment and some of the changes involved with the initial sleep restriction can seem daunting. It also requires a fee (£6.99 per week , or a one off of £49.99). It includes:

·        weekly online personalised 20min session with 'The Prof', a speaking cartoon character who talks you through each step. 

·        There are online tools and over 100 articles , with email reminders to help you stick to the programme.

·        There is also an online Sleepio community for those that want it. 

It has been studied in a RCT , so has excellent evidence to back up its use (Espie CA; Kyle SD; Williams C; Ong JC; Douglas NJ; Hames P; Brown JSL. A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. SLEEP 2012;35(6):769-781.).  

It helped 75% of people with persistent sleep problems, with an average reduction in time taken to fall asleep of 50%, and a 60% reduction in time spent awake during the night. Quality of sleep more than doubled, and energy levels increased by 58%. These improvements with Sleepio were found to be lasting because effects were maintained at the two month follow up point.

I prepared a single A4 summary of options for patients to look at which I give to patients with sleep problems. The other options I include are www.moodjuice.scot.nhs.uk (an excellent website with CBT based handouts on most mental health problems)  and also local counselling services.  It's also useful to staple this handout to those slightly awkward prescription requests for hypnotics- hopefully this reduces reconsultation for sleeping problems and reduces future requests for sleeping tablets. 

 

Dr Ian Kelt, GP Partner, Edinburgh

NB no ‘conflicts of interest’ guarantee: Dr Kelt, Dr Curtis and NB Medical Education have NO financial interest in Sleepio or any other books or products mentioned in our blog or on NB Medical courses.