Counting Sheep

5th October 2012

Jennifer Lipman lies awake at night
and thinks about insomnia…

Sitting in the doctor’s office, hot tears streaming down my face, I implored him to help. “I can’t take any more nights like this,” I pleaded. “I’m fed up.”

My complaint? Sleep, or rather my inability to achieve this basic human function. Happily for me, my plea was not left unanswered. That week, the doctor upped my dosage of sleeping pills.

By then I'd already been taking zopiclone – currently the most commonly used sleeping drug in Britain – for six months. And I’m by no means unique. A whopping 15.3 million NHS prescriptions were made for sleep medication last year. Put another way, recent research by the Economic and Social Research Council found that one in ten of us regularly uses a sleeping pill.

I’ve been struggling with insomnia since I was a teenager; a decade of sleepless nights tossing and turning and trying to read my mind into submission, of panicked 2am phone calls, and of endless trips to the bathroom simply to distract from the tedium of being awake.

“Heavy night,” a colleague asks with a knowing wink, as I rub my eyes. If only it was that simple.

Insomnia comes in many forms, from those who struggle to fall asleep to those who can’t stay so, or those who suffer from sleep apnoea and struggle to breathe while slumbering. For me, it’s the first; with an anxious, overactive mind, drifting off is a serious challenge.

To someone who has never experienced insomnia, it’s hard to do justice to the frustration that sets in in the wee small hours, watching the clock tick by, eyes sore and mind like cotton wool, yet still infuriatingly awake.

At least I’m not alone. According to the 2011 Great British Sleep Study around two thirds of Britons suffer from some form of sleep deprivation, whether temporary or permanent. The figures are marginally higher for women, and according to Professor Kevin Morgan, director of the Clinical Sleep Research Unit at Loughborough University “insomnia (as a clinical state) also tends to increase with age”.

Adrian Williams, a professor of Sleep Medicine at King's College, says insomnia is probably on the rise, due to a “23/7 society and lifestyle” and the stress that comes with that. Are more of us really suffering from it today, or is it just that more people are talking about it? Experts say that it’s probably a combination of both.

But it’s something of a hidden curse; nobody except your bedfellow knows just how long it takes for you to fall into the land of nod or how much you struggle to stay there. Professionals working in the field of sleep studies think it’s time this changes. “With stress and longer working hours on the rise in the current economic climate, it is crucial that we now treat the issue of sleep problems as the major public health concern it is,” says Dr Andrew McCulloch, chief executive of the Mental Health Foundation. Yet when insomnia does get a public hearing, it’s usually in the context of scaremongering about the rise in those seeking pharmaceutical remedy.

In February, newspapers reported a study, published in the BMJ Open journal, that found that sleeping pill users have a four times higher risk of death, and that sustained use exposes people to a veritable medicine cabinet of diseases, including cancer, lymphomas and oesophageal problems. Doctors also warn that pills may impair performance the following morning or increase susceptibility to myriad conditions including obesity and depression.

“Hypnotics should be used to treat insomnia only when it is severe, disabling, or subjecting the individual to extreme distress, and use should be restricted to short-term (two to four weeks),” cautions the Medicines and Healthcare Products Regulatory Agency.

So am I (and the millions of others like me) crazy to continue popping pills? “Short term use... is fine,” says Prof Morgan. “In fact, it’s often desirable. The problem is that insomnias are typically chronic – long term.” He doesn’t recommend “the long term use of sleeping tablets for chronic insomnia” and adds that “as clinical efficacy diminishes, dependence increases.” In other words, the more pills we take, the less our body responds to them, and yet the more we rely on them to sleep.

In a study involving 200 long-term pill users, overseen by Prof Morgan a few years ago, he found that “their sleep profiles (in terms of quality and quantity of sleep) were indistinguishable from those of untreated chronic insomniacs”. So not only are the pills bad for you, once you come off them the problems return.

All drugs affect our systems, and we’d be foolish to imagine sleeping pills are any different. The elephant in the room, though, is that the alternative isn’t good for our health either. The Mental Health Foundation found that “far from being a minor irritation, sleep disorders put sufferers at significantly greater risk of health problems ranging from depression, anxiety and bipolar disorder to immune deficiency and heart disease”. According to the Great British Sleep Survey, insomniacs are four times as likely to be dealing with relationship problems, three times as likely to lack concentration, and more prone to suffering from low energy. Other studies blame insomnia for making us fatter or putting us more at risk of a stroke.

“Sleep disorders can inhibit the very essence of who we are: our relationships, our mood, our ability to complete day-to-day tasks,” says Professor Colin Espie, director of Glasgow University Sleep Centre. “We can no longer just ignore the impact of sleep problems... they are affecting our health, our economy, and our everyday happiness”.

So, damned if we do, but damned if we don’t? There are other methods, although having been through the full gamut of herbal remedies, ‘sleepy teas’ and calming exercises, I wonder if those advising them have ever not nodded off the moment their head hit the pillow. Sleep courses at luxury spas, or an hour of meditation before bed just aren’t options for the majority of the workforce.

But there are alternatives that look more at the root of the problem, the most common of which is cognitive behavioural therapy. Doctors tend to recommend CBT (which is, at least in theory, available through the NHS) above all else. “The evidence shows that patients with insomnia rarely benefit from (and can be successfully treated without) laboratory sleep assessments,” says Prof Morgan. “Patients would be best advised to pester their GPs for an appointment with a ‘psychological practitioner’.” Everything else, he says, is a waste of their time and NHS money.

When my doctor agreed to increase my dosage, he also advised me to speak to a professional. I went once, and bawled for an hour about my personal demons. She was a kind, motherly woman. Perhaps she’d have done some good – if I’d been able to fund weekly private sessions and find the time for regular appointments.

There’s no escaping the fact that the long-term approach – getting to the bottom of our sleeping issues – is the ideal option. But until we see a fundamental shift in attitudes toward insomnia, whereby it is viewed not as an inconvenience, but as a medical condition like any other, can sleeping medication fill the gap? Prof Williams acknowledges that in the short term pills are “safe, and an option, rather than always advisable”.

Perhaps it’s about moderation. Two and a half years on, I'm still on sleeping pills. I’m responsible – I take them no more than twice a week – and my dosage remains the same. At 3am, still wide awake, that seems like a fair trade off.

Find Your Local