Can I use sleeping tablets while completing the Sleepful programme?
Yes. In general, sleeping tablets are only effective for 3 to 4 weeks of continuous use. After that, the effects begin to fade (this is called the development of 'tolerance'). However, the strategies you can learn in Sleepful are lastingly effective. If you are a long-term sleeping tablet user, you can use Sleepful to help you come off your medication - but we would advise discussing this with your doctor FIRST. Alternatively, if you have a limited prescription for sleeping tablets, you can use Sleepful as an effective and safe replacement.
Are 'over the counter' medicines effective treatments for insomnia?
Over the counter insomnia remedies (which don't require a prescription) include a range of herbal products (including valerian), and the antihistamine diphenhydramine. The evidence shows that valerian and other herbal products (chamomile, kava) are not very effective sleep-inducers, and differ little from placebo on a range of clinical outcome measures relating to sleep. Diphenhydramine, on the other hand, has long been known to induce drowsiness. While recommended for the short-term management of insomnia symptoms, longer term side effects can include constipation, dry mouth and headache. But again, like hypnotics, the fundamental problem with using drugs for insomnia is that the medicine don't really address the root cause of the problem.
Is Sleepful likely to help me if my sleep is disturbed by a chronic health condition?
The evidence shows that the self-help CBT-I approach used in Sleepful is effective for people with no other health complaints, and for people with chronic health conditions. This makes sense, since the CBT-I approach addresses the causes of insomnia through the drivers of sleep which operate in everyone. So, even though Sleepful may not affect the underlying health condition itself, it can certainly make any associated sleep disturbance more manageable. If you are in doubt about whether Sleepful is appropriate for you, discuss this with a healthcare professional involved in your care.
I have Obstructive Sleep Apnoea; can I use Sleepful?
There are many kinds of Sleep Disorders. Obstructive Sleep Apnoea (or OSA) is a Sleep Related Breathing Disorder characterised by multiple episodes of 'choking' during sleep which lead to excessive sleepiness during the day. These symptoms can be successfully treated by your GP or by a specialist chest physician or pulmonologist after appropriate assessment. These breathing symptoms will NOT respond to the procedures offered in Sleepful. However, many people with OSA also have insomnia symptoms (this is unsurprising; OSA is a chronic cause of sleep disturbance). So if, after appropriate treatment for your OSA, you still have problems getting to sleep or staying asleep, you may well benefit benefit from the Sleepful programme. We would suggest that you discuss this with your doctor first.
Can I use Sleepful with my sleep tracker?
One of the key aims of Sleepful is to get people to focus constructively on their sleep, and to recognise and preserve improvements in sleep quality. If you wear a commercial sleep tracker, then the information it provides could complement this aim, but we would add a word of caution. Insomnia is a complex condition which involves our experience of sleep quality and sleep quantity. Importantly, the successful treatment of insomnia doesn't always result in greater sleep quantity, but it does always result in greater sleep quality. People who are successfully treated feel better about their sleep, feel less fatigued during the day, and feel better about themselves. One way this works is that programmes like Sleepful help to make previously irregular sleep much more predictable - more controllable. So, if you wear a sleep tracker, don't just focus on the amount or even the 'depth' of sleep you are getting - it doesn't tell the whole story.
I'm a shift-worker - can I use Sleepful?
Shift-work, especially night-shifts, are a particular challenge for sleep. For regular shift-workers, several days a week are spent out of sync - we tend to be awake when our body thinks it should be asleep, and we want to sleep when our body is accustomed to being awake. In effect, it's like experiencing repeated episodes of jet-leg.
Some people cope with shift-work better than others. Many of those who choose to work shifts do so because they CAN work shifts - they are expressing a preference. Others, however, may have to work shifts because their occupation demands it. If you work shifts and you have insomnia symptoms, Sleepful can work for you - but you must be selective in the Steps you begin. A fundamental problem with shift-work is getting to sleep at unusual times of day - overcoming alertness in order to get to sleep. If you are a shift-worker, and getting to sleep is a problem, then the Steps covering Understanding Sleep, Sleep Hygiene, Thoughts and Sleep, and Physical Activity can help. However, Steps 4 (Making Time for Sleep) and 5 (Learning to Sleep) may not be practical. Our advice would be to work through the whole programme, but be prepared to follow only those activities which are practical for you.
Do CBT-I programmes like 'Sleepful' work for adults of all ages?
Yes; research has shown that CBT, delivered as self-help (like Sleepful), is effective among younger and older adults, those who are otherwise healthy, and those who have chronic health conditions. Older age is not a barrier to getting benefit from CBT for insomnia.
Would Sleepful be helpful for school-age kids with sleep difficulties?
Sleepful has been designed for the management of insomnia symptoms in adults. While the cognitive and behavioural factors underlying adult insomnia may also affect children, we would recommend a specialised paediatric assessment for any child with chronic sleep difficulties. Among very young children who "can't sleep", behavioural programmes have been shown to be effective, but the delivery of these programmes is best preceded by assessment, and might best be overseen by a professional. Adolescents are prone to disturbances of sleep phasing (especially during school vacations when the normal 'zeitgebers' are removed). Typically, a combination of later bedtimes and morning 'lie-ins' can re-schedule a young person's body clock, delaying the onset of the 'normal' phase for sleeping. This, of course, can create 're-entry' problems when the new term begins - but it isn't insomnia.
What's the best diet for good sleep?
There is little convincing evidence that you can eat yourself to sleep. Indeed, other things being equal, the timing of your meals is as likely to impact your sleep quality as the content. It is true that some foods contain molecules or minerals which feature in the physiological mechanisms of tiredness and sleep (magnesium, tryptophan, melatonin, etc.). But the research evidence is unconvincing that targeting foods which contain these products actually promotes sleep. That said, meals and mealtimes are important 'time keepers' in our 24 hour schedules, so maintaining some regularity in our dietary habits is important for maintaining a relatively smooth circadian rhythm. In addition, for some people (but not for everyone), consuming certain drinks and snacks is an important part of a pre-bedtime ritual which does promote sleep. But it's also important to recognize that, for people who don't habitually eat before bedtime, unaccustomed pre-bedtime snacks or milky drinks can actually disturb sleep.
Is insomnia more common among women?
Across all adult ages women are more likely to experience insomnia symptoms than are men. Overall, the female/male ratio of reported symptoms is approximately 1.4:1. Over the age of 45, however, this ratio rise to nearer 1.7:1. Explanations for this difference include menstrual symptoms, pre-, peri- and post menopausal symptoms, the challenge of pregnancy, pre- and post partum sleep disturbances (and the demands of breast feed), the gendered nature of care-giving (with implications for sleep continuity), and underlying chronic conditions (which are more experienced by women who tend to live longer than men). In short, culturally and biologically, women's sleep appears to be more challenged than men's sleep. In addition, it is also possible that symptom reports are affected by a gendered 'response bias' (women may simply be more comfortable reporting symptoms of vulnerability in epidemiological surveys).