1. O THER PSYCHIATRIC DISORDERS

2. Sleep disorder (Insomnia)

3. I NSOMNIA Difficulty initiating or maintaining sleep or getting up early Daytime impairment

4. S LEEP 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

5. 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 Inadequa te sleep hygiene N ON - PHARMACOLOGICAL T REATMENTS FOR I NSOMNIA Cognitive Cognitive Therapy Behavioral Sleep Restriction Stimulus Control Relaxation Educational Sleep Hygiene Education

6. S LEEP 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

7. S LEEP 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!

8. S TIMULUS 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

9. P HARMACOLOGICAL TREATMENT OF I NSOMNIA 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 Amitryptaline Dotheipin Quetiapine

10. Psychosexual dysfunction

11. P SYCHOSEXUAL DYSFUNCTION AND DRUG USE Use of substances, in particular opioids is associated with: Hypoactive sexual desire Erectile dysfunction Orgasmic dysfunction

12. M ANAGING 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