What this protocol covers
Someone who has slept badly for a few days and asks for something to help: what is checked before recommending anything, what fits and when insomnia is a sign of something else.
1. What to ask
- How long have they slept badly? Do they struggle to fall asleep, wake up, or wake very early?
- Is there something behind it: stress, night shifts, a trip across time zones, pain?
- Do they snore with pauses or fall asleep during the day? Do their legs bother them at bedtime?
- How is their mood? Do they have coffee in the afternoon, alcohol, or screens in bed?
- What medicines do they take? How old are they, do they drive in the morning, are they pregnant?
2. Refer if any of these appear
- More than 3 weeks, or daytime tiredness that stops them living their life.
- Low mood, severe anxiety or thoughts of death: carefully and without leaving it for another day.
- Snoring with pauses and daytime sleepiness: it could be sleep apnoea.
- Restless legs that stop them getting to sleep.
- They already take benzodiazepines, sleeping tablets, antidepressants or opioids and want to add something.
3. If there are no red flags
Always, and before anything else
- A fixed time for going to bed and getting up, weekends included.
- Bed is for sleeping: if they have not fallen asleep in 20 minutes, get up and go back when sleepy.
- No screens in the last hour, coffee only in the morning, and alcohol does not help: it breaks up sleep.
Time-zone change or shift work
- Low-dose melatonin for a few days, at the time they want to sleep.
If something more is needed, for a few days
- Valerian (traditional use): any effect appears after 2-4 weeks of use.
- A sedating antihistamine (doxylamine), only occasionally and for a few days, in adults who do not have to drive in the morning.
4. Adjust to who will take it
- Older people
- Avoid sedating antihistamines (doxylamine, diphenhydramine): confusion, falls and urinary retention. Sleep habits, and if that is not enough, the doctor.
- Pregnancy
- Sleep habits. No herbal products, melatonin or antihistamines without medical advice.
- Breastfeeding
- The same as in pregnancy: ask before any product.
- Long-term conditions
- On antidepressants, benzodiazepines or opioids, anything for sleep is checked first: the effects add up.
What not to recommend
- Alcohol to get to sleep.
- Combining several products that cause drowsiness.
- Doxylamine in older people or in someone who drives the next morning.
- Using an antihistamine for sleep on a regular basis.
Pharmacy Pills · conveniodefarmacia.com
Patient sheet: sleeping better
To print and hand over. It carries only what the patient needs at home.
- Go to bed and get up at the same time every day.
- Stop screens an hour before bed and keep coffee for the morning.
- If you have not fallen asleep in about 20 minutes, get up and go back when you feel sleepy.
- Do not drink alcohol to sleep or mix products that cause drowsiness.
- See your doctor if you have slept badly for more than 3 weeks or your mood is low.
Self-assessment
Three questions. When you check your answers you will see the explanation for each one.
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Sedating antihistamines in older people increase the risk of confusion, falls and urinary retention.
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Snoring with pauses and daytime sleepiness are the signs of possible sleep apnoea, which is diagnosed by a doctor.
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The monograph describes it as traditional use, with an effect that appears after several weeks.
Training content. It does not replace the summary of product characteristics or clinical judgement.