Author Archives: philipcrilly

Matthew Perry died of ‘acute effects of ketamine’ – what you need to know about the drug

Posted on by
Reply

Matthew Perry. s_bukley/Shutterstock

Philip Crilly, Kingston University

Millions of people worldwide were left devastated by the death this year of 54-year-old Matthew Perry, the Friends star famous for bringing wise-cracking Chandler Bing to life. A global superstar, recently sober with an autobiography on the bestseller lists, it looked like his troubled past was behind him. So the world was especially shocked and saddened to learn of his untimely death by apparent drowning.

This week, medical officials in Los Angeles, have confirmed that his drowning was more complex than initially suspected. Toxicology reports have indicated that two drugs were in Perry’s system at the time of his death. These were buprenorphine, a drug used to treat opioid drug addiction, and ketamine, sometimes referred to as special K or horse tranquilliser.

Given Perry’s well-documented addiction issues to opioid painkillers, his use of buprenorphine was not a surprise. But why was he taking ketamine?

Ketamine works by acting on receptors in the brain and, since its synthesis in the 1960s, has been used in veterinary medicine and also as a surgical anaesthetic in humans.

Medical person holding ampoules of ketamine
Ketamine is used as an anaesthetic in humans. luchschenF/Shutterstock

Following signs that ketamine might affect user mood, it was investigated for its potential role in treating depression and anxiety. Today, users can be prescribed ketamine for these conditions, but usually only after other antidepressant and anti-anxiety medications have failed.

The medical officer in LA specified that Perry was being legally prescribed infusions of ketamine to treat depression and anxiety. They did note, however, that given the time since his last dose, it was unlikely that the ketamine in his bloodstream was from his prescribed infusions. No other reason was offered as to why he would have had ketamine in his system so close to the time of his death.

In addition to finding drugs in his body, Perry was also listed as having heart disease. Ketamine can cause an increase in blood pressure and heart rate, so it is not surprising to hear from the medical examiner that: “At the high levels of ketamine found in his post-mortem blood specimens, the main lethal effects would be from both cardiovascular overstimulation and respiratory depression.”

Another contributing factor to Perry’s death was listed as drowning. So does ketamine make drowning more likely?

Ketamine can cause users to have issues with coordination, and they may feel disorientated. The combination of these effects while in water, can make a person’s reactions slower, putting them at risk of harm, so ketamine certainly could make drowning more likely.

Also, taking ketamine with other substances, like alcohol, can increase the risk of drowsiness. While Perry had a much-publicised issue with alcohol, his toxicology report indicated no alcohol in his system at the time of his death.

Not the first

Sadly, Perry is not the first Hollywood star to die by drowning under the influence of drugs. In 2012, global star Whitney Houston died in a bathtub after consuming marijuana, cocaine, and the benzodiazepine known as alprazolam (Xanax).

These stories remind us all of the dangers of substance abuse and the importance of seeking professional help for addiction issues.

Matthew Perry was a vocal advocate for more addiction support services, and since his death the Matthew Perry Foundation has been set up to help those struggling with the disease of addiction.

Perry said: “When I die, I don’t want Friends to be the first thing that’s mentioned, I want helping others to be the first thing that’s mentioned. And I’m going to live the rest of my life proving that.”

In the last years of his life, he did just that. But sadly, it seems that it will be in death that he will have the biggest impact on helping others to overcome their demons.

Philip Crilly, Senior Lecturer in Pharmacy Practice and Digital Public Health, Kingston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Harold Shipman was arrested a quarter of a century ago, but we still have problems with prescribing controlled drugs

Posted on by
Reply

Oleg Troino/Shutterstock

Philip Crilly, Kingston University

Catherine Hudson drugged two patients on the stroke ward of Blackpool Victoria Hospital to give herself an easier life. She has been jailed for seven years and two months. Her colleague, Charlotte Wilmot, who conspired with her to drug a third patient, was given a three-year jail term.

The trial highlighted the easy access staff had to controlled drugs. The drug regimen on the stroke ward was described during the trial as “dysfunctional”. But why is this still happening? Wasn’t it all meant to have been sorted following the Shipman Inquiry?

Harold Shipman, a seemingly mild-mannered family doctor, was responsible for the deaths of over 200 of his patients over 23 years. The true horrors of his actions started to slowly unravel in September 1998 when he was arrested for the murder of one of his patients, 81-year-old Kathleen Grundy.

It was the vigilance of Grundy’s daughter, Angela Woodruff, that would set in motion a series of events that would ultimately bring an end to Shipman’s long-running killing spree that began in the 1970s. Until that point, he had been able to kill his patients undetected by being careful to cover up his tracks.

There was a collective denial by the British public that a family doctor could have harmed one of his patients, let alone many of them. Yet, at the conclusion of his murder trial in January 2000, Shipman was found guilty of the murder of 15 of his patients. The true number of his victims, however, is believed to be 215.

Most of the victims were elderly women and Shipman’s weapons of choice were the controlled drugs, diamorphine, morphine and pethidine – strong opioid painkillers.

Controlled drugs are those deemed by governments to pose a high risk to the public due to being addictive or harmful. Shipman administered these drugs to his patients in high doses. At the doses administered, the victims would have quickly lost consciousness and developed breathing difficulties before passing away.

Following Shipman’s conviction, governments around the world sought to ensure that their controlled drugs regulations were sufficient to prevent similar events in the future.

Shipman Inquiry

The Shipman Inquiry was set up by the British government in 2001 to understand how one person could have used controlled drugs so freely to harm their patients and to determine what procedures needed to be put in place to prevent another person doing the same again.

The inquiry recommended not only a cultural change within the medical and pharmaceutical professions, but also the need for new laws to protect the public.

In its fourth report, the Shipman Inquiry focused on the management and regulation of controlled drugs. It recommended better monitoring of them, with running balances being kept for the sale and supply of specific controlled drugs in controlled drug registers.

Harold Shipman mug shot.
Harold Shipman, one of the most prolific serial killer in modern times. Wakefield Prison/Wikimedia Commons

In addition, a team of inspectors was to be appointed to check that controlled drug registers were being kept accurately, to track the prescribing of controlled drugs, and to monitor those who were prescribing them.

The inquiry recommended clamping down on self-prescribing and prescribing of controlled drugs for family members. It also limited the quantity that could be prescribed at any one time to a 28-day supply.

While the Shipman Inquiry only had oversight in the UK, its recommendations were relevant to an audience of global healthcare professionals and governments.

Still a problem

Despite all the changes, 25 years after Shipman’s arrest, controlled drugs are still a global problem.

While many of these medications have an important place in pain management, particularly for those with cancer, they are prone to abuse and misuse. In 2021 alone, the NHS spent over half a billion pounds on controlled drugs, and in the US, the opioid pandemic continues to rage, with people becoming addicted to opioid painkillers, like morphine and fentanyl, after obtaining them from registered prescribers.

The governance and oversight of controlled drug prescribing, in all healthcare settings, is still not as “robust as it should be”, according to the Care Quality Commission (CQC) in the UK.

It has suggested that digital tools, such as ePACT2, will allow authorised users to identify questionable prescribing of controlled drugs so that early interventions can be implemented to ensure safe care of patients.

In the US, prescription drug monitoring programmes are being used in a similar way to give real-time, controlled drug prescribing data to enhance care.

But just as these new tools come into play, more challenges are coming to light. The emergence of non-medical prescribers (paramedics, podiatrists, pharmacists, nurses, radiographers and physiotherapists) adds to the number of people who can prescribe controlled drugs, and, therefore potentially abuse and misuse them.

Winning the war on controlled drugs will continue to be a challenge. New drugs are brought to market every year, with the potential to cause harm and be categorised as controlled drugs. As such, the management of these drugs needs to remain fluid, with healthcare professionals and governments working together to protect the public from harm.

Philip Crilly, Senior Lecturer in Pharmacy Practice and Digital Public Health, Kingston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Popular nasal decongestant found to be ineffective by US drugs regulator – what it means for the UK

Posted on by
Reply

A.D.S.Portrait/Shutterstock

Philip Crilly, Kingston University

An advisory panel of the US Food and Drug Administration has found that a drug used in the majority of cold and flu products to treat blocked noses does not work.

The panel noted that phenylephrine, in tablet, capsule and liquid form, did not relieve nasal congestion. It did, however, point out that despite being ineffective, there were no concerns about its safety so people should not panic if they have been taking the drug.

In addition, the findings do not apply to the nasal spray version of the drug, which the panel did deem to be effective.

Phenylephrine first began to be sold in the UK in the 1970s. It acts by shrinking the blood vessels in the nose to improve air flow, thereby making it easier to breathe.

Today, phenylephrine is found in many of the UK’s staple cold and flu products, including Lemsip, Beechams, Sudafed and Benylin. Its popularity was cemented when another decongestant, pseudoephedrine, had restrictions placed on its sales in 2008 due to concerns about misuse, and phenylephrine was chosen as the main decongestant for many products.

Concerns first raised in 2007

Given that it has been used since the 1970s, many will be wondering why it is only now that phenylephrine is being deemed to be ineffective. The answer lies in the way the effectiveness of the drug is measured today compared with when it was first launched, with concerns first being raised in 2007.

When taking any oral medicine – tablet, capsule, liquid – the drug has to pass through the stomach before being able to have an effect. Some of the drug is broken down in the stomach, with the remainder being used by our bodies to treat our symptoms. Early research for phenylephrine showed that a third of the drug remained after leaving the stomach. This was deemed enough to affect nasal congestion.

More recent research, however, used more accurate methods and noted that less than 1% of phenylephrine remained after leaving the stomach. This figure was deemed too low for the drug to have any meaningful effect.

It is for this reason that only the oral forms of the medication are deemed to be ineffective, as the nasal spray does not have to go through the stomach and acts directly where it is needed.

Today, there are also more accurate ways to measure improvements in nasal congestion compared with when phenylephrine was first tested, and, again, oral phenylephrine did not show any effect at all using these newer methods.

So, are we about to see many of our family favourite medicines removed from pharmacy shelves?

In the US, the FDA states that it needs to consider the findings of the advisory panel before taking any action. However, CVS Pharmacy, the largest chemist chain in the US, has announced it will remove from its shelves certain oral cough and cold products that have phenylephrine as the only active ingredient.

In the UK, the drug’s regulator, the MHRA, has issued a statement. Alison Cave, the agency’s chief safety officer, said: “There have been no new safety concerns identified with phenylephrine-containing products and people can continue to use as directed.”

With temperatures getting colder and the cold and flu season fast approaching, many people may now be confused about what to do for their stuffy noses. It is important to remember that neither the US nor the UK drug regulators have suggested removing oral phenylephrine from pharmacy shelves.

For those who want to try alternatives, however, the nasal spray version of phenylephrine is still deemed to be effective. Also, pseudoephedrine tablets from behind the pharmacy counter, as well as steroid nasal sprays, saline nasal sprays, and steam inhalation therapy with menthol vapour rubs, are other options.

As ever, the local pharmacist is the best person to speak to about any drug queries, and for advice on the best treatment options for the cold and flu season ahead.

Philip Crilly, Senior Lecturer in Pharmacy Practice and Digital Public Health, Kingston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Viral TikTok raises concerns about a commonly prescribed contraceptive – what you need to know

Posted on by
Reply

Philip Crilly, Kingston University

A viral TikTok video by online influencer Morgan Roos has panicked some users of a commonly prescribed injectable contraceptive called Depo-Provera. In the video, Roos said she was shocked to learn the contraceptive she had been using for ten years was only recommended for a maximum of two years.

Roos said she was only told this when she switched to a female doctor. Many viewers commented that they too had been using Depo-Provera for years – some for as long as 17 years without any guidance from healthcare professionals, male or female, that they should have stopped after just two. But is there really cause for panic?

Depo-Provera is a progestogen-only injectable contraceptive and is administered every 13 weeks, meaning users don’t need to remember to take a pill every day. When used as directed, it is 99.8% effective at preventing pregnancy.

It acts by preventing ovulation, the release of an egg from an ovary, and also makes the environment where the sperm reaches the egg less hospitable. However, it is not just used for contraception. Some women use it to reduce heavy periods or to reduce the pain of endometriosis.

While Roos did not explain why her new doctor had advised that she should have stopped Depo-Provera after two years, there are a few potential reasons why.

Potential harms

Depo-Provera has been associated with a reduction in bone mineral density, meaning that users may develop weak and brittle bones. This risk is deemed to mostly be reversed once Depo-Provera is stopped. However, some loss may not be replaced.

Factors such as the age of the person using the medication may affect their risk levels. Adolescents under 18 are advised to try other contraceptive methods first as they are particularly vulnerable given that their bones are still developing and growing. Also, users over 50 are encouraged to use another form of contraception.

Other potential risks associated with using Depo-Provera include a delayed return to fertility, by up to one year, meaning it can be hard to get pregnant straight after stopping the contraceptive. Depo-Provera has also been associated with weight gain, acne, mood changes and decreased sex drive.

In the US, the Food and Drug Administration and the drug’s maker, Pfizer, suggest Depo-Provera “should not be used as a long-term birth control method (that is, longer than two years) unless other birth control methods are considered inadequate”.

In the UK, the Faculty of Sexual and Reproductive Health, the body that sets standards and offers guidance on prescribing contraceptives, issues slightly different advice. Its guidance for progestogen-only injectables recommends users be reviewed every two years to discuss the benefits and risks of continuing to use the medication.

So, regardless of which country you are in, it is always wise to ask your doctor to review your Depo-Provera – at least every two years – to determine if it is still appropriate for you.

For those who would still like to use Depo-Provera, strategies to reduce the risks of lessened bone mineral density include taking a calcium and vitamin D supplement, as well as doing weight-bearing exercises regularly.

And for those for whom Depo-Provera is not suitable, other contraceptive methods are available and include oral birth control pills, vaginal rings, barrier methods (such as condoms) and intrauterine devices. Bear in mind that barrier methods are the only contraceptive method that also protects against sexually transmitted diseases.

Philip Crilly, Senior Lecturer in Pharmacy Practice and Digital Public Health, Kingston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How technology could solve the social care crisis

Posted on by
Reply

With the recent furore surrounding the Tory policy to make the elderly pay for their own care, does this signal the start of a new era in which we are all called upon to contribute to our own health, care and wellbeing? Recent statistics from the Office of National Statistics (ONS) indicate that this may well be the case!

The proportion of the UK population over the age of 65 is estimated to reach 25% by 2045, up from just 18% today. With more people requiring care and less people working to sustain the economy, we are facing a health and care crisis.

But what if technology could change the way we deliver care? What if the caring roles undertaken by carers and family members could be replaced by machines and robot technology? While there may be some upfront financial costs, the costs of maintaining this type of care could be much more affordable.

Many may initially feel reluctant about this type of approach, but as our lives get busier and the costs of care increase, advances in technology may be the key to solving this social care crisis.

Four NHS-approved mental health support apps

Posted on by
Reply

With #mentalhealthawarenessweek drawing to a close it’s worth taking a look at the free mobile apps available to support those living with a mental health condition. The following apps are NHS-approved. None of the apps listed are intended to replace medical advice and if you are concerned about your or someone else’s mental health you should seek medical attention.

  1. Chill Panda

Google Play or Apple App store

This fun app is mainly aimed at children and adolescents but those of us who are young at heart may also enjoy using it. The central character is, you guessed it, a Panda, chosen because of its calm and peaceful nature. Developed by a clinical psychologist, it is a fun way to relax and distract yourself when feeling stressed and anxious. The app has a number of supportive features under the banners of Feel, Chill, Do and Play.

Feel – Placing your finger over your smartphone camera allows the app to take your heart rate. You are then promoted to say how stressed or anxious you are feeling using a sliding scale. Based on your heart rate and response, the Panda will then recommend some activities to make you feel better.

Chill – As the name would suggest this section is designed to help you relax. Through the use of square breathing exercises, you breathe in and out at a steady rate in time with the Panda. This will slow your heart rate and help you feel more in control of your breathing.

Do – keeping active is well-documented as a way to reduce stress and anxiety and this has been incorporated into Chill Panda. This section prompts you to do light exercise and stretching as well as “Panda Yoga”. The exercises can take as little as 5-minutes to complete – enough time to help you feel relaxed again.

Play – Two games within the app are intended to distract you from whatever it is you are anxious about. The “Painter” game is based on the concept of colour therapy, encouraging you to be creative by colouring in a number of different templates. The “Panda on point” game involves tilting your phone to get the Panda to a certain point on screen. It’s a fun distraction and great way to put a smile back on your face.

Chill Panda also has some useful information, for adults and children, about what anxiety is and helpful tips on how to manage it.

  1. Stress and Anxiety Companion

Apple App store

This great little app helps you to control your breathing, relax, reframe your negative thoughts and develop new techniques to manage stress and anxiety.

The home screen welcomes you with a number of choices: Relax now; reframe a thought; or create a card.

Relax now – Find a quiet space to lie down and listen to a number of recorded relaxation exercises.

Reframe a thought –Identify a negative thought that you are having. Now identify what triggered this thought. Give as much detail about the negative thought as you can and rate how anxious it is making you feel. The next step is to think of a new, more realistic, thought that you could use instead. Going through this process helps you to think realistically about your fears and concerns and helps you to stop catastrophising them.

Create a card – The app allows you to create positive affirmation cards, with beautiful, scenic backgrounds to admire.

In addition, there are also breathing tools and distraction brain games e.g. count down from 1000 in sevens until you reach zero or practice your times tables. These games can interrupt negative thinking. There is also a section to learn more about anxiety, relaxation techniques and the impact of diet, exercise and sleep on anxiety levels.

  1. Catch It

Google Play or Apple App store

Similar to the Stress and Anxiety Companion this app encourages you to challenge negative thought processes. When logging in for the first time you are prompted to create a pin. This ensures that no one can see your private thoughts. The app encourages you to think through your negative thoughts in 3-stages: Catch it; check it; and change it.

Catch it – record details of your mood at a particular time – what mood are you experiencing? How strong is the mood on a scale of 1-5 (5=strongest)? When and where are you experiencing this mood? What happened or what prompted you to feel this way? What were you thinking about just before this mood game on? Answering all of these questions helps you to identify your mood triggers so that you can do something about them.

Check it – Read over what you’ve written in the Catch it section and think of different ways that you could look at the situation

Change it – Now, what would be a more helpful thought process? Write it down and then rate how your mood changes from the start.

  1. FearFighter

Google Play or Apple App store

FearFighter is a 9-step cognitive behaviour therapy (CBT) course designed to be completed over 9 weeks. It contains videos, questionnaires and tools to help those people suffering from any form of panic or phobia to overcome these. Each step takes around 50 minutes to complete and the app recommends that you complete each step fully at one time. The course aims to teach you a wide range of coping skills and techniques to help you through times when you are feeling particularly scared or anxious.

All of the apps listed above have their own unique benefits. They are all free so download them all and see which one you prefer. These tools are available to support you to feel better so why not get started today?

 

 

Social media and pharmacy – are we missing an opportunity?

Posted on by
Reply

reemFile_000

Dr Reem Kayyali and Philip Crilly

Facebook, Twitter and Instagram are just three social media platforms that are taking the world by storm.

According to a report by Ofcom, “In the UK, nearly all 16-34s are online (98%) and two-thirds (66%) of them have social networking profiles. Those who have a current online profile (96%) have one on Facebook and 83% of 16-24s visit social networking sites more than once a day.” People aged 55 and older now represent the fastest-growing age segment in global social networking usage, with the penetration of social networks in this age group being around 80%.

Recent research on social media use suggests that there are no significant differences in use by race, ethnicity or socioeconomic status. This suggests that health interventions delivered by social networking sites may be an effective way to reach adults from different genders, ethnicities and socioeconomic groups. Such factors have proven to be barriers for some patients accessing services from pharmacies.

Social media offers pharmacist’s innovative opportunities to further enhance their role in educating patients on healthy living initiatives. With the younger generation growing up with this technology, evidence suggests that this has increased their levels of sedentary lifestyle with a massive impact on obesity levels among the young. Pharmacists can harness this by using it to promote healthy behaviours such as weight loss, alcohol awareness and physical activity in a way that ensures they are engaged.

As patient acceptance increases and pharmacists become more familiar with the concept of social media as a health education tool they will find that it is a quick and convenient route to keep track of health outcomes allowing them to not only support individual patients but also the wider public.

In fact, at Kingston University we have tried to investigate this concept as a tool for public health promotion. Students promoted topics ranging from smoking cessation to stress relief and nutrition. The outcome was, not only did the public learn about these health topics through the evidence based posts, the students also learned from creating and posting these meaning a unique learning opportunity which current pharmacists can also benefit from.

Social media can be used to highlight the key role that pharmacy plays in supporting patients with their health needs. It can be used as a health promotion tool and is a good way to build links within the local communities and beyond. It raises the profile of the profession and also offers a unique opportunity for pharmacists to share and showcase good practice.

Managing your weight

Posted on by
Reply

obese-women4001

The number of people in the United Kingdom who are overweight or obese is starting to spiral out of control. Current statistics suggest that over 50% of British adults are overweight and many of these are at risk of becoming obese.

With a population becoming increasingly overweight the risks of heart disease, diabetes and other long term health complications are reaching scary heights.

Weight loss programmes range from diet based schemes like weight watchers, to self help books such as Dr Atkins diet to those that combine diet and exercise classes like Rosemary Conley’s eat yourself slim diet.

What are the risks associated with being overweight

As mentioned, being overweight can have a serious impact on our health. Some of the risks associated with obesity include

  • Heart Disease
  • High Blood Pressure
  • Cholesterol problems (leading to heart disease)
  • Stroke
  • Type 2 Diabetes (the kind you develop rather than are born with)
  • Cancers (prostate, gallbladder, colorectal, breast, endometrial and kidney)
  • Sleep Apnea (Snoring and difficulty breathing while sleeping)
  • Reproductive problems (irregular periods, increased birth defects, especially neural tube defects, and an increased risk of death of the mother and baby).

What diets are out there currently?

Currently, there are a huge abundance of ‘fad’ diets on the market. Very often these diets give us short term results and in the long term, many people actually put on more weight. The reason these fad diets work initially is because they make us dramatically cut the calories we consume so therefore we will naturally lose weight.

The problem with ‘fad’ diets is that they usually aren’t easy to maintain. As soon as you go back to your normal life, the weight generally goes back on.

The key to losing weight and keeping it off is to make the appropriate lifestyle changes and to stick to them. A diet low in fatty, processed foods and high in fruit and vegetables helps us maintain a healthy physique.

What role does exercise have in weight management?

When you exercise you burn calories. The more vigorous exercise you do, the more calories you burn and the more weight you lose. Current recommendations suggest that we should aim to do five thirty minute sessions of exercise per week. Ideally, we should aim to combine cardiovascular exercises like swimming, which help heart health, with weight-baring exercises such as squats or running which help to build strong joints.

Exercise, is not only key to weight management, other benefits include:

  • It helps you manage your mood – exercise triggers brain chemicals that make you feel good. Regular exercise is encouraged to combat depression.
  • You’ll feel more energetic
  • You’ll sleep better
  • If you do exercise with friends it can even be fun.

Maintaining a healthy weight helps ward off many serious illnesses. Just making a few small lifestyle changes involving diet and exercise can dramatically improve our health in the future.

 

8 ways to sleep like a baby

Posted on by
Reply

sleep well

Click this picture to view this article as a slideshow

Sleep has many important functions to keep us feeling healthy and happy. We all know the feeling after having a great night’s sleep. We are fresh and relaxed and ready to face the world. But equally, having a bad night’s sleep can leave us feeling moody and unhappy and can affect our performance throughout the day.

There are a whole range of sleep disorders that affect millions of people. These include sleep apnea, night cramps and insomnia (prolonged periods of poor sleep). Overcoming these problems is essential for optimum health so let’s have a look at some of the things you can start doing now to improve your ‘sleep hygiene’ and to get a great night’s sleep!

1) Have a bedtime – going to bed at the same time each night is important to help you get into a good bedtime routine. Your body will come to expect going to bed at this time and will, therefore, fall into a sleep much easier.

2) Keep your bedroom cool – a cool room is a much better environment to sleep in than one that is too hot and stuffy. Open your bedroom windows about an hour before you’re ready for bed to let some fresh air in. Of course, consider the outside weather when doing this!

3) Avoid caffeine-containing products four hours before bed – Tea and coffee, as well as some energy and soft drinks, contain lots of caffeine which can keep the mind active if taken too close to bedtime. Some people are particularly sensitive to this so if this is you then try to avoid these products up to four hours before bed.

4) Keep a notepad by your bed – as mentioned in the article on coping with stress, writing down your worries or concerns can help alleviate some of the stress. If your lack of sleep is because you are worried about something, write it down and then deal with it in the morning when you are feeling fresh and your mind is clear.

5) Don’t read or watch TV too close to bedtime – reading or watching TV before bed can stimulate the brain and keep it ticking over as you are trying to sleep.

6) Get plenty of exercise (but not too close to bedtime) – exercise can be a great way to help you unwind and rest easier. Be careful not to exercise too close to bed though, the increased body temperature may prevent you from getting your 40 winks.

7) Try a power nap – Sleeping during the day can mean that you aren’t very tired by night time. If you do feel tired in the daylight hours try going for a quick 15 minute power nap to give you a quick burst of energy that won’t keep you up all night.

8) Seek out a sleep expert – sometimes there may be an underlying reason behind your inability to sleep. Seeking help from a sleep expert may allow you to identify why you are having trouble sleeping and this can help you deal with the problem head on. There are specialist sleep clinics throughout the UK that can support you with this to help you get a great night’s sleep.