Athletes' insomnia, mental health & prescription sleep medication reliance

 Pre-existing insomnia is a primary risk factor for first episode depression. 40-50% of insomniacs have a comorbid mental disorder. Insomniacs are 10 times more likely to have clinical depression, 17 times more likely to have clinical anxiety. It starts early: paediatric research links childrens' sleep disturbance with anxiety and depression.  So poor sleep affects mental and physical health; Poor mental and physical health affects sleep.

And the perceived "go-to" for sleep problems - prescription sleep medications - is found by the clinical research to complicate the sleep picture further. According to the Victorian Coroners Court, Benzodiazepine sleep prescription medications were involved in 55% of 384 overdose deaths investigated in 2014, up from 49% four years earlier. Thereafter the medications Xanax and Valium were moved to Schedule 8, or restricted prescribing status. Even with availability of the newer BZRA "Z drugs" medications (which themselves have been associated variously with sleepwalking, sleep-eating and sleep-driving complications), the benzodiazepine medications, such as Temazepam and Diazepam, remain by far the cheapest and most widely prescribed sleep medications in the Australian community.

Australian athletes are not immune to the promise of sleep medications. In fact, the urgency for sleep solutions hits athletes harder due to tiredness and energy deficit that follows poor sleep. Tiredness, fatigue and energy loss translates immediately into poorer sports performance, and greater risk of injury. Thus sleep quality has a direct link to athletes performance and wellbeing. But rapid tolerance to sleep medications quickly creates a worsening cycle of insomnia, frustration and further medication dependence that invariably costs the athlete, when the margin of error in sports performance is incredibly small.

There are recognised evidence-based treatments for insomnia that negate the need for prescription sleep medications, and better an athlete's mental health and wellbeing.

The Royal Australian College of General Practice (RACGP) released these Clinical Guidelines: "Cognitive behavioural therapy (CBT) for chronic insomnia is effective and therefore should be offered as first-line treatment;" and "Psychological and behavioural treatments ...have shown robust and stable improvements in sleep continuity for up to 2 years."

A sample of 5 (semiprofessional) athletes treated by the author, along with others suffering insomnia and struggling with sleep medication misuse, believe:
"Insomnia causes serious physical health consequences" (88% strongly agree)

"Poor sleep will interfere with my next day functioning" (80% strongly agree)

"my poor energy and functioning is due to poor sleep the night before”(84% strongly agree)

"(I'm) Better off taking sleeping pill to function, than having poor sleep" (61% strongly agree)

But only 13% agree "medication is probably the only solution". (all others unsure or disagree) (LetSleepHappen and Sydney Sleep Centre)

Simply put, athletes and other insomnia patients, did not believe that the best, or only, solution was sleep medication.  They just felt helpless and frustrated and believed the cost of sleep problems to their functioning was too great. Overwhelmingly the athletes and other insomnia clients wished to have skills beyond use of prescription medications, but just hadnt known how CBT worked to help overcome insomnia fears longterm.  Hence the goal amongst sleep physicians, sleep psychologists and pretty much every professional working in the sleep field is to widen awareness of the evidence-based cognitive behavioural treatment that works for insomnia.

Rosemary Clancy
Sleep Specialist Clinical Psychologist