John (not his real name) came to see me yesterday. “Doc, can I get some sleeping tablets, I am having trouble going to sleep and staying asleep.” John is a 35yo man, married with two children, working as an accountant. He is a regular of the practice, and this is the first time he has mentioned that sleep is an issue. “John how long has this been an issue?” I asked, “well it has been on and off for about six months but has been really bad for the last month or so” he replied. “I lay awake thinking about things; my mind just won’t switch off. It can be about anything, conversations I had during the day, decisions I have made, arguments with my wife or work colleagues. Work has been more stressful lately with changes there. I am sure if I can get some sleep, I am sure I will get better.” On further questioning there has been some increasing conflict between John and his wife, and he has started shaking and sweating at the thought of going to work and going home. He has also found that his thoughts have become a little darker of late, his motivation has declined, he no longer exercising, consuming more alcohol and making poor choices about his diet.
John has developed an anxiety disorder. The root cause of this will need to be further explored, usually it is a combination of multiple issues, work, home and loss of resilience. Addressing these issues will be complex, however the most important part for John is acknowledging that there is an issue, that cannot be solved though the use of sleeping medication. He would benefit from a variety of psychological therapies including relationship counselling, cognitive behaviour therapy, talking therapy, mindful training and possible medication. Early interventions such as online eHealth assistance (see below) may help and, with careful monitoring by the GP, a short-term use of a benzodiazepine may assist. This would be no longer than 3 days.
