The sleep of St Just

Why should a sleepy town in Cornwall house the country's first GP insomnia clinic? Lynne Wallis investigates

St Just, a small sleepy town on the Cape Cornwall coast, seems an unlikely setting for what is believed to be the country's only GP clinic for insomniacs.

It cannot be the stark beauty of the coastline that keeps the people awake at night, nor the sound of the sea. Perhaps it is financial worries - residents of the Penwith peninsula have the lowest average weekly income in Britain. Some put it down to the weather, saying the wind is too strong; others to the quiet way of life. "Nothing ever happens here. People just don't burn enough calories off to sleep," said a Penzance taxi driver.

Whatever the cause, the man determined to do something about the lack of sleep in St Just is Dr William Jago, a local GP, who opened a weekly clinic in March and already has a four-week waiting list. St. Just's insomniacs have come out of the closet.

"Insomnia affects a person's functioning in all areas of their life," says Dr Jago, "and there is a real illness associated with sleeplessness. Getting to the cause of it is crucial, and then it needs to be managed properly, not just drug treated. If it's temporary - linked to an event like bereavement, moving job or home - then it's perfectly fine to prescribe drugs. But often such events set patterns of sleeplessness that can last for years unless they are treated."

In April a medical avisory panel of sleep experts supported by a drug company launched a campaign, "Sleeptalk", to raise awarenes of insomnia. The survey found 72 per cent of sufferers were moody or depressed and 62 per cent had problems concentrating. Worryingly, 10 per cent said their insomnia had caused an accident.

Research conducted by the Sleep Research Laboratory at Loughborough University shows 16 per cent of all vehicle accidents are sleep related. The Sleeptalk survey found 20 per cent of insomniacs said they had not slept properly for more than 10 years, 8 per cent for 20 years, and that women are twice as likely as men to have insomnia and four times more likely to seek help. Two-thirds of sufferers consult their GPs but 20 per cent receive no advice or treatment.

At his surgery, Dr Jago first assesses the patients and asks them to complete a sleep diary, monitoring the time they go to bed, estimated time of falling asleep, total sleep time, and number of times they awaken during the night.

"This is important because a lot of people who think they don't sleep at all get more than they realise," says Dr Jago. Many who swear they have not slept a wink find in fact that they have slept for three or four hours.

Insomniacs then attend group sessions run by the surgery nurse for four weeks, to try to get their sleep patterns back to normal.

The Cape Cornwall clinic advises "warm-up" exercises before sleep, such as tensing all the body's muscles in turn, then relaxing them; playing a soothing tape, or reading. Beds should be replaced every 10 years. Food and drink before bedtime should be avoided, as should emotional upsets, noise and light, all of which may keep people awake. A reduction in fluid intake may be advised if frequent trips to the lavatory are disturbing sleep, and some patients have found yoga and relaxation classes helpful. One elderly sufferer has stopped taking sleeping pills after 20 years since attending the clinic.

"Alcohol's the worst thing," says Dr Jago. "It's excellent for helping you to get off to sleep, but as the alcohol by-products break down, it will disrupt sleep later on. Smoking and caffeine should be avoided, too."

Current insomnia buzzwords are "sleep hygiene", a method of improving patients' sleep environment. The temperature of the room, for example, should be just right and there should be no noise. "We should keep our bedrooms for sleep," says Dr Jago. "No television or eating in the bedroom, and no vigorous exercise before bed. Except sex. That's OK. But if we start taking work papers to bed, we start associating bed with work, not sleep."

He says that as we get older, we need less sleep. A young baby can sleep almost constantly, a toddler half the day. Teenagers can happily sleep until lunchtime, but by our twenties we usually get around six to eight hours a night. By our sixties, when we are less active, we need considerably less. "Elderly people tend to catnap during the day," says Dr Jago. So it is the deep sleep at night, the really important stuff, that tends to be disturbed.

Around 48 per cent of older sufferers have sleep onset problems, another 46 per cent wake too early in the morning, and 73 per cent wake throughout the night and have difficulty getting back to sleep.

Olive O'Sullivan, 82, has suffered from insomnia for 35 years. Once very fit, she overdid things and one day slipped a disc. "I was in plaster, and that was when my sleep first became disturbed," she tells Dr Jago during her first visit to the clinic. "It takes me about three hours to get off now and if I wake, I can't get back off. I'm always having to cancel plans because I'm too tired." The Mogodon she once took gave her shallow sleep but nightmares, too, so she stopped taking it.

Her big mistake was lying in late if she had not slept, a tempting, but fatal, move. "It's unrealistic to say we'll make you sleep like a teenager, but we can help," Dr Jago tells her. He proposes agreeing a time with her when she will go to bed and get up, that there will be no napping during the day, and never, ever, any lying in. She already sleeps separately from her husband, who "sleeps like a log and snores all night long", but used to leave the radio on at night to help to mask her tinnitus (ringing in the ears).

Patricia Matthews, in her seventies, takes half a "moggy" most nights, but still has not slept more than about four hours a night for more than 20 years. "It's been a build-up of stress and family difficulties that's caused it," she says. "I worried so much at night abut my daughter's asthma, I couldn't get off. It's stayed with me. I'm awake between 4 and 5am most mornings. As soon as I wake up, I think, Oh God, not again."

When Mrs Matthews is really tired, she goes to bed early and this, says Dr Jago, is her mistake. "If you make yourself stay up and stick to the same time, eventually it'll improve," he says. Routine, it seems, is the key to the cure, as the body then learns what time to sleep. In addition, Dr Jago recommends "stimulus control therapy", cutting out the drugs - no more moggies for Mrs Matthews.

Dr Chris Idzikowski, of the Sleep Assessment Advisory Service, a help organisation for GPs on sleep matters, the future for insomniacs seeking help from GPs is looking brighter. "There are 30,000 GPs in the country and they are just beginning to realise that they don't know much about sleep. I think we may see more clinics like Dr Jago's starting up.

Dr Jago points out that the clinic "is only an hour a week.If it is successful, and other GPs run them, it actually means GP workloads could get lighter, because nurses can run the clinics once the assessments are done. They won't have all the patients with insomnia-related symptoms to see."

Insomnia information packs are available from the Medical Advisory Service, PO Box 3087, London W4 4ZP for £1 plus an SAE. The helpline number is 0181-994 9874 and is in service from 2pm to 10pm Monday to Friday.