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Currently available NHS treatments for Insomnia

Written by David, London

The gap between NHS provided sleep services and currently available treatments, research, studies and services provided in some other countries is large. I say this as someone who has suffered from chronic lifelong insomnia and has had to self-diagnose the condition after, by necessity, familiarising myself with insomnia and circadian rhythms by reading hundreds of medical and scientific research papers.

I have had to then pay to speak to sleep experts (highly qualified and experienced consultants at the London Sleep Centre in Harley Street) who confirmed my diagnosis and the current course of treatment I was by the embarking on was correct. The condition was a strongly delayed sleep phase (Delayed Sleep Phase Syndrome) that resulted in me not being able to sleep until 3.00am or even as late as 5.00am, thus resulting in chronic insomnia which perpetuated itself further.

The treatment is melatonin tablets taken an hour before bedtime, tablets that I can not get on the NHS despite asking numerous GP's, hospital doctors and even a sleep centre consultant I have been referred to. I have to import the tablets myself from America, where they are available on the pharmacy shelf (as a dietary supplement) and only cost about 4 dollars.

I also use a light therapy unit for 30 minutes in the mornings, also not provided or even recommended at any time by the NHS. I have had to make the unit (ensuring it meets all standards and requirements) myself. However, the result of the treatment is that I can now sleep very well by 11.45pm and wake up at a good time in the morning without feeling drained and fatigued. This good sleep pattern has been going on without a single bad night for many months now. This is with the use of no sleeping tablets, alcohol, over the counter sleep aids or anti anxiety drugs.

Melatonin is a natural hormone (also found at low concentrations in foods) made in the brain that regulates sleep. In normal people, the brain makes it late evening and it makes them sleepy. In people with circadian rhythm problems, it is much later (as in DSPS) or almost random (n-24). However, the NHS will not provide it. Harley Street would, but it is £220 a month to buy from pharmacies under private prescription as it is not mass produced in this country or imported from others.

I sought treatment from the NHS for a period of ten years, most intensely in the final three years. The NHS 'treatment' was a course of zopiclone or zolpiderm which I built up tolerance to and had unpleasant side effects for periods up two years, occasionally punctuated by benzodiazepines when times got 'very bad'. This is completely at odds with current scientific and medical research that recommends light therapy (long term) and melatonin (at least in the short term, possibly long term) as also recommended by expert sleep consultants and practiced in some other medically advanced countries including America.

Using the right treatment (that I still have to import myself despite the London Sleep Centre informing my doctor was the correct form of treatment by letter, and build/maintain the light unit I made myself) has made me a normal sleeper.

Under NHS treatment I was depressed, could not sleep at all on many nights or very late on others, was eventually unable to work and was fatigued much of the time. Life did not feel like living. However, now things are an awful lot better. The NHS also offered me psychodynamic therapy, my GP believing psychological rather than biochemical issues were causing my sleep disturbance.

In retrospect, this would have been a waste of time and if anything perpetuated the condition as it failed to work or address the biochemical nature of the problem. So NHS treatment is not lacking purely because of financial reasons (although my assessment at an NHS sleep centre in London was in a portacabin), it is mainly lacking as information and expertise in the rapidly expanding field of sleep medicine is not getting down through the medical community to GP's and most importantly to the patients.

My experience with the NHS is that regarding sleep conditions, in reality only Obstructive Sleep Apnoea, Narcolepsy, Restless Leg Syndrome or a handful of Para-insomnias are effectively diagnosed or treated as they either fall into the category of lung function, can be treated with stimulants or can be easily diagnosed if not treated.

Regarding other disorders, in particular circadian rhythm disorders (i.e. adult DSPS effects 0.5% percentage of the population from recent studies, therefore in a practice with 100,000 patients, 500 patients in the practice will have DSPS) which are treatable and vastly reduce the quality life if left untreated, the NHS seems not to be able to offer available treatment or even advice, despite such conditions responding well to treatment in a large number of cases.

David, London

Thanks David for this excellent article

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