Insomnia Clinic

Sleep is important.

That’s why when we don’t sleep well, night after night, we can be left feeling exhausted and miserable; like everything we do in our day is an uphill battle.

It affects everything, from our mood and motivation, to concentration and memory, to our physical health.

Regular difficulty in getting to sleep or staying asleep is known as insomnia.

It may be that you have suffered insomnia for only a few months or maybe, like many of our patients, for years or even decades.

During this time you have probably been offered little to no help or treatment.

There is good news. We can help you.

It may be that you know what triggered your poor sleep pattern or maybe there was no clear cause.

Either way, it is likely that there are now some things you are doing, some ways that you are thinking, and some responses that you can’t control in your body, that actually make it harder for you to sleep.

Insomnia is often a bad habit that the body has got stuck with, and we know that when we change the cognitions (thoughts and images), behaviours and automatic responses (conditioning), sleep almost always improves.

We call this treatment Cognitive Behavioural Therapy for Insomnia (CBT-I).

CBT-I is the most effective intervention for insomnia and there is a huge amount of evidence which demonstrates this.

It is more effective than medication, has fewer side effects and improves sleep in the long term.

NICE guidelines and international guidelines recommend that all patients be considered for CBT-I prior to any other sleep treatment (i.e. medication).

We take referrals from GPs and a whole range of medical professionals.

GPs can refer using the choose and book system.

Paper referrals from other health professionals can be posted or emailed to:

 

Insomnia Clinic

Royal Surrey County Hospital

Egerton Road

Guildford

Surrey

GU2 7XX

Email: rsch.insomniateam@nhs.net

 

Unfortunately, we cannot accept self-referrals nor provide private appointments.

We are also unable to accept referral for anyone under the age of 18 at present.

 

 

As you probably know, there is no magic wand to instantly improve sleep, therefore treatment is a programme of around 5 sessions usually completed over a period of weeks.

We want to equip you with insights and tools that will help you relearn how to sleep well.

Our aim is that once you finish our programme, if your sleep is disturbed in years to come, you will have the knowledge and confidence to use these tools again.

Disclaimer: Your sleep will not improve if you do not put our advice into practice!

This sounds like an obvious point, but some people are not in a place emotionally or practically to put changes in place and therefore this treatment will not work.

If on the other hand you are willing to change your practices, but lack confidence or need help problem solving, we can help you with that.

 

You will be seen by a qualified medical professional who specialises in sleep and has considerable experience and knowledge in this field.

 

We currently have Insomnia clinics at the Royal Surrey, Cranleigh Village Hospital and Farnham Memorial Hall.

 

Yes. As there are very few Insomnia services in the UK, we have people coming from a very large geographical area.

 

Your first appointment is an assessment where we gather information about your sleep problem and the factors that influence it, such as your lifestyle, your sleep environment, your physical and mental wellbeing.

We also ask you to fill in some questionnaires and sleep diaries.

It is helpful if you come to your first appointment having completed these.

Through building a picture of you and your condition, we can identify whether insomnia treatment would be the best option for you, or whether you need any other medical investigations, such as a blood test or a sleep study or referral to another professional.

 

 

Your assessment and reviews will be one to one.

Therapy is sometimes done in groups.

Although many people don’t like the sound of groups, they offer immense benefits in terms of being supported by others with the same problems, reducing the waiting time for treatment and increasing the breadth of advice we can share with you.

 

CBT for insomnia is often very different to the CBT that someone might receive for anxiety or depression.

What we do still targets thoughts (cognitions) and behaviours, and does not involve prescribing medication, hence being classified CBT, but it also integrates specialist knowledge of sleep and techniques that are only used to resolve sleep disorders.

We also borrow aspects of coaching (to help motivate people to change their behaviour) and Acceptance and Commitment Therapy (ACT) as these help people to reduce their effort to sleep (which so often makes it harder to sleep) and cope with the impact of sleep loss.

ACT techniques are not traditionally included in many CBT programmes.

 

There are many guided self-help options that use the same treatment approach to that which we do (CBT-Insomnia).

This may be an effective option for you if you are highly motivated and apart from your sleep problem, you are fit and well, but would struggle to get to repeated appointments with us.

 

There are many books on the market and we have not read all of them, but we have confidence in either of the following:

Overcoming Insomnia and Sleep Problems: A Self-Help Guide Using Cognitive Behavioral Techniques

26 Jan 2006

by Colin Espie

 

The One-week Insomnia Cure: Learn to Solve Your Sleep Problems Paperback

16 Feb 2017

by Professor Jason Ellis

 

Alternatively, you could use an interactive web programme such as Sleepio or Sleepstation.

 

It may be that you are taking a sleep aid such as medication, either from the GP or that you have obtained yourself.

We do not force people to stop their sleep aid although many people come to our clinic wanting to be able to sleep without taking sleep aids.

If this is your goal, we would recommend that you discuss this with your GP.

We will support your GP and give you strategies that reduce your need for sleep aids.

Please note we do not have a prescriber as part of our insomnia clinic, so we are not able to prescribe sleeping medication or change current prescriptions.

There is a two way relationship between sleep and mental health.

Therefore people with mental health problems often have difficulty sleeping.

Also, insomnia can cause low mood and make the symptoms of mental health worse.

Sometimes it is hard to establish which service is best for you if you have a mental health problem and insomnia.

If you answer ‘No’ to the questions below, it is likely you would benefit from another mental health service first, until you are ready to engage with us:

• Is your mental health problem being addressed and managed by another professional?

• Is your condition fairly stable at the moment?

• Are you committed to adopting advice by making suggested changes to your daytime and night-time routine and activities?

Please be aware that although we provide a type of CBT, we do not have the resources to manage primary mental health conditions.

People requiring frequent, intense and focussed treatment for their mental health condition, should be referred elsewhere.

At the Royal Surrey Insomnia Clinic we only treat insomnia and nightmare disorder.

If your main complaint is daytime sleepiness and snoring, you will need to be referred to our 'Respiratory Sleep Clinic' which can assess for and treat sleep apnoea.

If your main complaint is sleep walking or acting out your dreams, you may need to be referred to a sleep neurology service at another hospital (as currently we do not have one).

In reality, we know that sometimes insomnia happens alongside other sleep problems, therefore during your first appointment we will screen for many sleep disorders like sleep apnoea, periodic limb movements, sleep walking and others.

We will then make a decision as to which service will best meet your needs, and refer you on if necessary.

If you have a Circadian Rhythm Disorder, we can often help to improve your sleep quality and establish a more regular pattern, but we may have to refer you elsewhere, if you wish to shift your sleep phase.