OTHER PSYCHIATRIC DISORDERS

Sleep disorder (Insomnia)

INSOMNIA

Difficulty initiating or maintaining sleep or getting up early

Daytime impairment

SLEEP DISORDER AND DRUG USE

Sleep disturbance is extremely common among alcohol and other drug users

Sleep disturbance is prevalent during withdrawal states

Episodes of insomnia are extremely distressing and can trigger relapse following a period of abstinence

• Unrealistic sleep expectations

• Misconceptions about sleep

• Sleep anticipatory anxiety

• Poor coping skills

• Reduce excessive time in bed

• Correct irregular sleep schedules

• Avoid sleep incompatible activities

• Avoid hyperarousal

• Inadequate sleep hygiene

NON-PHARMACOLOGICAL TREATMENTS FOR INSOMNIA

CognitiveCognitive Therapy

BehavioralSleep RestrictionStimulus Control

Relaxation

EducationalSleep Hygiene

Education

SLEEP HYGIENE Arise at the same time each day

Limit daily time in bed to ‘normal’ amount (6–7 hours)

Discontinue use of drugs that act on the CNS such as caffeine, tobacco, alcohol, opioids and stimulants

Avoid daytime napping

Exercise in the morning and remain active throughout the day

Substitute watching television at night with light reading and listening to music

SLEEP HYGIENE Have a warm bath near bedtime

Eat on schedule; avoid large meals at night

Follow an evening relaxation routine

Ensure comfortable sleeping conditions

Spend no longer than 20 minutes awake in bed

Use the bed only for sleep and sex!

STIMULUS CONTROL AND SLEEP RESTRICTION Go to bed only when sleepy

Get out of bed when unable to sleep

Increase sleep efficiency (time asleep as a percentage of time in bed)

Aim to restrict time in bed with average time actually asleep

Wake up at the same time irrespective of how much you slept

Alarm and help from family members

PHARMACOLOGICAL TREATMENT OF INSOMNIA Avoid using sleep inducing drugs such as

benzodiazepines and other drugs such as Zolpidem in drug users (due to increased likelihood of dependence)

When drug treatment is necessary to promote sleep, use drugs such as

Trazadone Mirtazapine

AmitryptalineDotheipinQuetiapine

Psychosexual dysfunction

PSYCHOSEXUAL DYSFUNCTION AND DRUG USE

Use of substances, in particular opioids is associated with:

Hypoactive sexual desire

Erectile dysfunction

Orgasmic dysfunction

MANAGING PSYCHOSEXUAL DYSFUNCTION

Stopping or even reduction of dose of opioids may improve sexual function

Compared with methadone, buprenorphine is less likely to be associated with erectile dysfunction

Alcohol impairs sexual functioning: “Provokes the pleasure but takes away the performance”

Comorbid depression is often responsible for the psychosexual dysfunction and hence management of depression is important