In the two decades I have been a GP, the NHS has instructed us to tell patients the same thing about sleeping tablets: don’t take them.
These drugs, such as benzodiazepines (or benzos as they are often called), have been shown to be highly addictive. Such is the concern that earlier this year health chiefs issued another strong warning to family doctors urging them to stop prescribing sleeping pills immediately.
Which is why it is all the more shocking that, according to official data, 14,000 sleeping pill prescriptions are still handed out on the NHS every day. How is this possible?
The answer is because patients are not being offered any alternative.
Insomnia – struggling to sleep – affects about one in five adults.
In the short-term it can affect mental health and ability to perform daily tasks. Long term, it raises the risk of diseases such as dementia and Parkinson’s.
And when patients are pushed to desperation, they beg their GPs for sleeping pills who, in turn, often relent against their better judgment. However, for every patient who gets a sleeping pill prescription, there are countless others who are refused any treatment at all.
What makes this so frustrating – and tragic – is that there are two effective and safe treatments available on the NHS.
The first is Sleepio, an app that delivers cognitive behavioural therapy for insomnia, known as CBTi. This is a form of talking therapy that aims to help patients get to the bottom of what is causing their insomnia – such as depression or stress.
CBTi is the treatment doctors are supposed to offer first, but NHS therapy waiting lists are years-long. As a result, the Health Service has started offering CBTi via Sleepio. It is a six-week programme that acts as a coach, with weekly interactive sessions and a daily diary used to work out how much sleep patients actually need.
It can take weeks, but gradually people sleep for longer.
Yet despite the fact it has technically been available on the NHS since 2022, many parts of the country are refusing to fund it. This is outrageous, not least because the app is cheap, costing the NHS just £45 per patient.
Insomnia affects about one in five adults. Short term it can impact mental health and ability to perform daily tasks. Long term, it raises risk of diseases such as dementia and Parkinson’s
The second overlooked treatment is daridorexant, a tablet approved in 2023 for insomnia lasting at least three months where CBTi hasn’t worked or isn’t available. Rather than sedating the whole brain, it blocks orexin, a chemical that keeps us awake. It has not been found to cause the dependence seen with older pills.
GPs can also prescribe over-55s a short course of melatonin, the body’s own sleep hormone.
Neither is a long-term solution. Both are there to help patients who need help resetting their sleep schedule. In particular, melatonin should not be taken for too long as people can become dependent on it for sleep. It’s why I always advise against buying it abroad – where it is often available over-the-counter. But I do advise to try taking magnesium every night for a few weeks, as my patients often say it can make a difference.
Finally, the most important step that patients can take themselves is to look at their sleep hygiene.
This means improving the conditions in which we sleep. That might mean darkening the bedroom with blackout blinds or wearing an eye mask. Ear plugs might help, and many people tend to sleep better in a cool room so it can be worth investing in a fan or air-conditioning.
Screens should be out of the bedroom, not only for the light they emit but for the dopamine rush and stress of checking a phone. In my own experience, even cutting down on phone use during the day improves my sleep.
Exercise helps too, but is too stimulating in the evening so do it earlier in the day. In the last hour or two before bed, avoid eating and caffeine, and don’t be fooled by alcohol – although it makes you dozy, it reduces sleep quality.
I truly believe that poor sleep is one of the biggest health issues affecting this country. That’s why it is so important that doctors and patients alike educate themselves on the steps to beating insomnia.
A new care service is a laudable plan, but can you see it working?
I’m sceptical of Andy Burnham’s plans to create a National Care Service.
Our current care system is nothing short of a mess. I see its failings week in, week out, for my patients as well as my friends and family.
But simply saying you want to create a National Care Service is far easier than doing it.
It will be eye-wateringly expensive, meaning the Government will almost certainly need to raise taxes to fund it.
And much of the care in the UK is provided by private companies – what happens when this public service takes over? Will they go out of business? Or will the Government pay them to continue at sky-high prices?
It’s a laudable goal from the Prime Minister, but at the moment there are far more questions than answers.
Do you think that Mr Burnham’s plans for a National Care Service will succeed?
Please write in using the email below and let me know.
Your questions answered
I have suffered with piles for more than a year, making going to the toilet agony. The cream has not helped. What should I do?
Piles, also known as haemorrhoids, are a common issue and can be agonising.
They are essentially varicose veins of the lining of the rectum. The membrane covering these veins is fragile and they are easily damaged, causing bleeding, and pain when using the loo.
More common in people who struggle with constipation, piles also typically affect those with added weight pressure on the area, such as pregnant women, obese or overweight people and sometimes weight lifters.
In most cases, piles won’t last for more than a week, but if symptoms continue for longer it is vital to see a GP for a rectal examination.
This is because while pain, bleeding or lumps around the back passage are usually piles, they can also be signs of a more serious issue – including, in rare cases, cancer. To rule this out, a simple stool test can be sent from the GP.
If going to the toilet is agony, it could be something called an anal fissure – a tear in the anus. This can be treated using over-the-counter pain relievers or prescription healing creams and muscle relaxants.
Keeping bowel movements soft and easy to pass is a vital first step, as constipation can cause patients to strain as they go to the toilet, which can cause rectal veins to swell, making things worse.
Eating foods that are rich in fibre, such as kiwis, dates, raspberries, lentils, peas, seeds and nuts, is crucial for easing constipation.
So too is drinking plenty of water.
If these changes don’t work, then stool softeners or laxatives may be needed, or a GP can offer a referral for more invasive treatment, including surgery.
