What lifestyle modifications can I recommend to patients with insomnia, and how effective are they compared to pharmacological treatments?

Lifestyle modifications recommended for patients with insomnia include:

• Establishing a consistent bedtime routine.
• Avoiding caffeine, especially close to bedtime.
• Reducing stimulating activities before sleep, such as watching violent or exciting television programmes or films.
• Engaging in relaxing activities that encourage sleep.
• Improving sleep hygiene overall.

These non-pharmacological approaches are considered first-line and are important to implement before or alongside any pharmacological treatments.

Effectiveness compared to pharmacological treatments: Lifestyle and behavioural interventions, including sleep hygiene advice, are preferred initially because they avoid the risks associated with medications, such as dependency and side effects. Pharmacological treatments (e.g., zaleplon, zolpidem, zopiclone) are recommended only for short-term management when lifestyle modifications are insufficient, and even then, caution is advised due to potential misuse and side effects. Therefore, lifestyle modifications are effective and safer as a first step, with pharmacological treatments reserved for short-term use if necessary.

This approach aligns with NICE guidance emphasizing the importance of sleep hygiene and cautious use of drugs for insomnia, particularly in vulnerable populations such as those with borderline personality disorder.

Summary: Recommend lifestyle changes focusing on sleep hygiene and bedtime routines as the primary intervention for insomnia, reserving pharmacological treatments for short-term use when these measures fail or symptoms are severe.

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