Insomnia

Review good sleep hygiene practice with patients. Advise patients that:

• They should avoid stimulants (e.g., caffeine, nicotine) and alcohol for several hours before bedtime, and avoid using blue-light-emitting electronic devices (e.g., smart-phones) in the hour before.

• They should allow adequate time to relax before bed.

• They should have an environment conducive to sleep, with minimal noise/light and proper temperature.

• It is best to avoid clock-watching, which can lead to hyperarousal.

• They should avoid excessive time in bed, aiming to sleep only as much as they need to feel refreshed the next day.

• Most importantly, they should attempt to maintain a regular sleep schedule, with consistent bedtime and rise times, and avoid daytime naps. Especially, a regular rise time leads to a regular sleep onset time and helps to set their circadian rhythm.

For patients who are taking hypnotics, explain about adverse effects, including possible next-day drowsiness that might impair activities that require alertness, including driving. Also advise them about rare, but potentially serious, adverse events. These include the following:

• Complex sleep-related behaviours, such as sleepwalking, sleep driving, and cooking. On rare occasions, these may lead to serious injury or even death. If they experience these behaviours, they should stop taking the drug and contact their healthcare professional right away.

• Anaphylaxis or angio-oedema, which can occur as early as the first time the drug is taken.