Some antidepressants do have a sedative effect and

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Some antidepressants do have a sedative effect, and research has shown that people who were treated using a combination of sleeping medication and antidepressants showed greater improvements in depressive symptoms than people who used antidepressants only 72 73 . However, the British Association for Psychopharmacology advises against using antidepressants in the treatment of insomnia as there is limited evidence indicating their efficacy in this application 74 . It is difficult to gauge how many prescriptions are written for hypnotics because many of these drugs are prescribed for problems that are not directly sleep-related. Up to 40% of people with insomnia may self-medicate with hypnotics that are available without a prescription, and many people also drink alcohol to aid sleep. Hypnotics may be effective for short- term acute insomnia, particularly for conditions like jet lag. However, they only act on the biological, neurochemical factors to help us sleep. Many people develop tolerance to hypnotics and become physically or psychologically dependent, or suffer withdrawal symptoms such as anxiety, depression and nausea. Some types of hypnotic, such as benzodiazepines, can cause ‘rebound insomnia’, which is often worse than the original insomnia symptoms. Also, hypnotics can have a range of side effects. The National Institute for Health and Clinical Excellence 75 , suggest that hypnotics should only be used after other measures have been tried, and then only for short periods of time, such as 2–4 weeks maximum. Use of sleep medication dates back thousands of years; Hippocrates noted the sleep- inducing properties of opium in c.400 B.C.
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‘Sleeping is no mean art: for its sake one must stay awake all day.’ Friedrich Nietzsche
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57 56 It has also been used to treat people with a range of mental health problems such as depression and anxiety, and is part of the Improving Access to Psychological Therapies (IAPT) agenda. It can be used alongside hypnotics or without. A comprehensive CBT approach for insomnia includes a variety of techniques, such as sleep hygiene regimes (as described previously), relaxation training, readjusting sleep patterns, and altering the thoughts and behaviours that hinder people from sleeping 77 78 . The importance of relaxation should not be taken for granted. People with insomnia tend to find it hard to relax naturally before going to bed. Relaxation training involves paying attention to breathing and ensuring that muscles are not tensed up. People who have trouble sleeping should ‘wind down’ in the hour before going to bed, possibly doing relaxing activities such as listening to music. The act of relaxation does not always come naturally and may require patience, discipline and practice. Activities that some people consider relaxing may not be appropriate for others. For this reason it may be helpful to have a tailored relaxation programme developed by a CBT practitioner.
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