Drug treatments for sleep problems

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If your sleep problems continue, you should speak to your GP, rheumatologist or rheumatology nurse, who’ll be able to offer more advice and prescribe suitable medications if you need them.

There are four main groups of drugs that can be helpful. They’re most likely to have an effect when just one factor is causing your sleep disturbance. You may find it useful to take a combination of drugs from more than one of these groups. Your GP or hospital specialist will be able to advise on which drugs are most likely to help you.

Painkillers

Taking paracetamol (with or without codeine) just before going to sleep can ease pain for a time to allow you to get to sleep, but it’s unlikely to last all night. Non-drowsy painkillers that include caffeine are unlikely to help you sleep.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Slow-release NSAIDs such as ibuprofen or naproxen reduce pain and stiffness throughout the night. Although these drugs have potential side-effects, they can be very useful.

Sedating antidepressant drugs

Some antidepressants such as amitriptyline, dosulepin and trazodone have sedative effects, which means they make you feel sleepy, and may also reduce chronic pain. These drugs aren’t given as sleeping tablets but may improve your sleep as an added benefit. It’s often advisable to take them a few hours before going to bed so that the effect has worn off by the morning.

Sedatives (hypnotics)

Temazepam, zolpidem and zopiclone are given specifically to help you sleep. They’re sometimes called hypnotics. They help you to go to sleep but may not stop you waking during the night. Doctors often advise against using sedatives in the long term because of the risk of dependence, which means you become addicted to them. There's also a risk of side-effects, but they can be very helpful for short-term use. In some cases long-term use of these drugs may be better than long-term loss of sleep.

Many people experience painful muscle cramps during the night. Quinine sulphate can be a useful drug to reduce these pains, though it doesn’t work on other types of pain. Your doctor will look to see if any medication you’re taking could be causing the cramps (for example diuretics or statins) and will suggest stretching before you go to bed. If this doesn’t help, they may prescribe a short course of a drug called quinine sulphate, which can be a useful drug for reducing these pains, though it doesn’t work on other types of pain.

In addition there are other drugs that are usually prescribed in people who have chronic pain and these drugs may sometimes have useful effects on sleep, for example pregabalin and gabapentin. 

Other treatments

Some rheumatology clinics offer evidence-based self-management groups which deal with fatigue and sleep issues. Ask if your rheumatology team offer this. Visiting a therapist or psychologist may also be helpful. They may be able to offer relaxation tips or cognitive behavioural therapy (CBT), a psychological treatment based on the assumption that most of a person’s thought patterns and emotional or behavioural reactions are learned and can therefore be changed. The therapy aims to help people resolve difficulties by learning more positive thought processes and reactions.

A number of studies have investigated CBT as a treatment for sleep problems in people with chronic pain. CBT can be given either in group sessions or to individuals and aims to help people change any thoughts, feelings or behaviours that may be having a negative impact on sleep. CBT uses a number of different techniques:

  • Education teaches about sleep and the factors which help or disturb it (including sleep hygiene).
  • Sleep restriction aims to improve sleep efficiency (the proportion of time in bed that is spent sleeping). This is based on the principle that lying in bed awake for long periods makes sleep problems worse in the long term. Bed times and getting-up times are changed to better reflect how much sleep you get.
  • Stimulus control aims to help people link the bed only with sleep and sex. Common strategies include removing the TV from your bedroom and not working or reading in bed.
  • Cognitive therapy helps people to spot and assess any negative thoughts and beliefs about their ability to sleep.
  • Relaxation and imagery training can be helpful for people who find it difficult to shut off their mind from the events of the day. Relaxation and imagery techniques can help people to distract themselves from stimulating thoughts. 
     
     
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