It is not necessary to completely abstain from alcohol or caffeine. Limiting alcohol and caffeine intake is certainly important to avoid insomnia, but the amount currently being consumed by Mrs Browning is unlikely to be the only cause of her sleeping problems. You might suggest that she replace the afternoon cup of tea with herbal tea.
A short 15 to 30 minute nap early in the day may improve night time sleeping as will doing physical activity early in the morning. Regular physical activity helps promote good sleep, but increases energy and alertness in the short term, so it is better to exercise early in the day.
Advising the consumption of tryptophan containing foods, such as warm milk and bananas, may help prolong sleep. There is some evidence that intake of high protein foods at night may lead to increased wakefulness, so avoidance of these foods at night is usually recommended.
Cognitive behavioural therapy usually consists of a 12 week program concentrating on sleep hygiene, sleep restriction, stimulus control, cognitive restructuring and muscle relaxation. This appears to be at least as effective as pharmacologic therapy and the effect may be more sustained. It can also be used to effectively taper or withdraw sedative/hypnotic medications. Regular meditation has also been shown to improve the quality of sleep.
Use of benzodiazepines (hypnotics or sedatives) is not recommended due to;i) altered pharmacokinetics and dynamics as we age that result in prolonged half life and “hangover”effectii) association with increased risk of falls and fracturesiii) the possibility of rebound insomnia or anxiety on withdrawal.
