Global Health Asia-Pacific September 2020 September 2020 | Page 16
You Ask, They Answer
Q
: In which cases are sleeping pills recommended
and how helpful are they?
A
: In cases of acute insomnia, which typically lasts less
than one month, we recommend short-term medications
when the insomnia is severe or associated with substantial
distress. However, in chronic cases, when sleep is disrupted
at least three nights per week for at least three months, longterm
use of medications is indicated but only after appropriate
identification and management of precipitating and
perpetuating factors (e.g., irregular sleep schedule or taking
caffeinated beverages after lunch) and when the patient fails to
respond to cognitive behavioural therapy.
These medications are generally effective in causing sleep
and reducing the risk of chronic insomnia, and they are well
tolerated with short-term use. But when used long-term, they
can result in side effects and become habit-forming.
Q
: What’s the difference between prescription and
over-the-counter sleep aids?
A
: In general, over-the-counter sleep aids are usually
traditional herbs (e.g., valerian) or supplements (e.g.,
melatonin), but these have variable results and may not be
effective in some patients. Prescription medications, like
benzodiazepines, antidepressants, and antipsychotics, are
usually more effective but need to be prescribed by a doctor
because of the potential side effects and addiction.
Q
: What are the most problematic side effects?
A
: The common side effects of some of the
medications include residual daytime sedation,
drowsiness, dizziness, lightheadedness, cognitive
impairment, motor incoordination, dependence, and
respiratory suppressants that can worsen obstructive sleep
apnoea or hypoventilation (shallow or low breathing).
Q
: Do patients have difficulty going about their
business due to these side effects?
A
: It depends on the severity of the side effects. If they’re
mild and tolerable, the patient can still function.
However, they can sometimes be severe and debilitating.
Q
: What are some effective drug-free alternatives?
A
: Behavioral counselling focusing on sleep hygiene
and stimulus control, behavioural therapies
(including relaxation, sleep restriction therapy, cognitive
therapy, and cognitive behavioural therapy for insomnia),
and acupuncture are a few alternatives.
Q
: What does good sleep hygiene involve?
A
: Good sleep practices include sticking to a regular
sleep schedule, exercising regularly but not four
to five hours before bedtime, avoiding caffeinated beverages
after lunch, alcohol near bedtime, and prolonged use of lightemitting
screens before bedtime, not going to bed hungry,
and avoiding smoking, especially in the evening. People
should also sleep as much as they need to feel rested and
then get out of bed, as well as go to sleep only when they feel
sleepy.
Dr Edwin Chng
Dr Edwin Chng is the medical director of Parkway Shenton
in Singapore.
14 SEPTEMBER-OCTOBER 2020 GlobalHealthAsiaPacific.com