Search

Self Care Pharmacy Blog

 

Insomnia: Not just about sleep

December 2nd, 2013

by Chelsae Ward, PharmD student

Insomnia is one of the most common patient complaints for Americans, third only to headache and the common cold. It is estimated that 33 percent of the United States population experiences insomnia.1 As defined by the CDC, insomnia “is an inability to initiate or maintain sleep.” 2 While the symptoms of insomnia are similar and easily identifiable, the causes can be vast and often hard to determine. Many times insomnia is not the primary condition but the effect of an underlying problem. One of the major causes of insomnia is emotional unrest due to either excitement or stress/worry. Therefore, insomnia is often a tell sign of depression or other emotional disorder. Pain or physical disturbances are also a common cause of insomnia. Other times, sleep disorders, such as sleep apnea cause insomnia.3

Rxdaily.com, a pharmacy news website, reviewed a study on the effects of insomnia in the article, It’s More Than Beauty Sleep.”4 The study was conducted by the CDC and looked at the correlation between insomnia causing diabetes and/or heart disease. Specifically, they focused on insomnia caused by mental distress and obesity. The study used over 50,000 participants who were 45 years and older. It concluded that a majority of people (64.8 percent) were optimal sleepers in terms of amount of time spent sleeping each night. Those who were short sleepers (31.1 percent) were more likely to develop heart disease, stroke, mental disorders, obesity, and diabetes. The authors of the study point out limitations in that it is difficult to determine which of the factors are the cause and which are the effect. For example, does insomnia cause diabetes or does diabetes cause insomnia? Sleep expert, Robert S. Rosenberg, states that the former has been most evidenced in recent studies.4 Another limitation was that the study was open to recall bias because the participants gave their own opinions on their sleep habits. The Rxdaily article concludes that medical professionals need to be more attentive to patients sleep patterns and habits.4

I agree with the Rxdaily article that health care professionals, including pharmacists, need to be attentive to a patient’s sleeping habits. Recognizing insomnia in patients can help identify a possible disease state since insomnia can be either a cause or effect of many disorders.5 Based on this knowledge it would make sense that Health Care Professionals would be attentive to a patient’s insomnia. One way in which this process can be easily implemented is to begin asking patients with a known medical history of heart disease, diabetes, obesity, or stroke of their sleeping habits. Along with this step, health care professionals can stress the importance of quality sleep to all patients, and thus the patient can address insomnia if/when it becomes a problem for them.

Not only is it important to pinpoint insomnia in patients due to its ability to cause medical issues, but many patients attempt to self-treat insomnia with over-the-counter medication (9 percent) or alcohol (11 percent).1 Pharmacists, being the best patient contact for over-the-counter medication, need to be aware of their patient’s insomnia. The pharmacist can then appropriately guide the patient on the best way to treat their insomnia. Benadryl, the most common over-the-counter sleep aid, may be used beneficially in short-term insomnia; but its use is not recommended long term.1 Many patients believe that alcohol will help to solve their sleep insomnia. It is important that alcohol users are aware that while alcohol may initially cause drowsiness and help one get to sleep, it will be more difficult to stay asleep. Many people will wake up more frequently throughout a night with alcohol use.6

The best way that has been found to treat chronic insomnia is through sleep training (also known as sleep hygiene), in which the patient trains themselves in proper sleeping habits.7 Sleep training are basic steps to take in order for one’s body to be in a suitable sleeping environment. It is important to keep a steady sleep schedule in which the patient will go to bed at the same time every night and wake at the same time every morning. The bedroom should be quiet, dark, and a place where the patient feels they can relax. The temperature of the room should not be too hot or too cold. The bed should be comfortable to the patient, neither too soft nor too firm. The bed should only be used for sleeping, making sure activities like reading, watching TV, or completing work, are done outside the bedroom. It would also be helpful to avoid large meals two hours before bedtime. Avoid taking naps throughout the day. If still unable to fall asleep, it is recommended to, instead of trying to force sleep, carry out a relaxing activity away from the bedroom.1,2

With the new evidence linking chronic illness and insomnia as found in the research study reviewed by rxdaily.com, and the high rate of self-treatment for insomnia, it would seem, not only important, but also necessary for health care professionals to be aware of patients sleeping difficulties. Do you think the health benefits of sleep are being under-rated in today’s health system?

 

References

1) Melton, C. K. Insomnia, Drowsiness, and Fatigue. In: R. R. Daniel L. Krinsky, Handbook of Nonprescription Drugs An Interactive Approach to Self-Care. Washington, DC: American Pharmacists Association; 2012: 867-876.

2) Sleep and Sleep Disorders. Centers for Disease Control and Prevention. http://www.cdc.gov/sleep/index.htm. May, 2012.

3) Staff, M. C. Insomnia. Mayo Clinic. http://www.mayoclinic.com/health/insomnia/DS00187. Janurary, 2011.

4) Robert S. Rosenberg, D. F. It’s More Than Beauty Sleep. Rxdaily.com. http://www.dailyrx.com/chronic-illnesses-may-be-associated-poor-sleeping-habits-study-suggests. October, 2013.

5) Lawrence Robinson, G. K. Sleeping Pills & Natural Sleep Aids. helpguide.org. http://www.helpguide.org/life/sleep_aids_medication_insomnia_treatment.htm. May, 2013.

6) Szalavitz, Maia. Sleeping It Off: How Alcohol Affects Sleep Quality. Time: Health and Family. http://healthland.time.com/2013/02/08/sleeping-it-off-how-alcohol-affects-sleep-quality/. February 8, 2013.

7) Reinberg, S. Prescription Sleep Aids Common Choice for Insomnia. WebMD. http://www.webmd.com/sleep-disorders/news/20130829/prescription-sleep-aids-a-common-choice-for-american-insomnia. August 29, 2013.

Tags:

6 Responses to “Insomnia: Not just about sleep”

  1. Aaron Le Poire Says:

    I thought this was a very interesting article, and very practical. There are definitely a lot of people who suffer from insomnia, and it’s important to know as health care providers when a patient is suffering from it. I think it would be very beneficial for more studies to be done that look at how insomnia could cause those disease states, or vice versa, depending on what the mechanism actually is. If that were to be more thoroughly researched, it could lead to a better understanding of insomnia and how to treat or prevent it. It would also allow health care providers to monitor patients who may have insomnia and what disease states they may be at an elevated risk to acquire.

    The tips on sleep hygiene were very helpful, and I think people should try to follow those guidelines before turning to pharmacological help. The fact that so many people suffer from insomnia makes these tips even more crucial for people who may have trouble falling asleep. I would also be interested in seeing how health care providers can help their patients after they have established their sleeping problems. Would they just monitor them for other disease states or would there be something they could specifically do to help them? I think that would be an interesting topic to do further research on as well if more is discovered about a link between these two conditions.

  2. Caleb Lyman Says:

    It is really shocking how little is known about insomnia and its causes and association with diseases. This indeed seems like an area of research that deserves some attention. I think that sleep is definitely not prioritized in today’s society as it should be. The role of sleep and the presence of insomnia need to be demonstrated to both patients and pharmacists. Sleep is another area where medication is thought of as a quick fix to an unbalanced lifestyle. However, unlike exercising or eating a balanced diet, these healthy sleeping tips seem much more attainable and practical for the average patient. I think that if patients were made aware of these simple strategies many would be able to at least try a few and see how their sleeping may improve.

  3. Gina Mattes Says:

    I thought this article pointed out a good part of our health system that is lacking. I think that all health care professionals including pharmacists should be aware of their patients sleep patterns, especially if they already have a disease like diabetes. I think that training yourself to sleep could be hard, but I think it would also be helpful to exercise to help people sleep. Exercise can also help people with other diseases like Type 2 diabetes. This might be able to help improve insomnia as well as other health problems too. I agree with the article. Sleep habits today are being under rated, but I think that it can be hard to rate them because, like the article, people are rating their own sleep habits. We would have to come up with a scale to measure insomnia to better help all our patients.

  4. Chelsae Ward Says:

    Aaron, I think you are correct in the question that you brought up as it is one that I wondered myself for awhile. I think that providers could help patients with the sleep training as an attempt to avoid any issues down t road. But also, I think that providers can take extra care in checking these patients with admitted insomnia for early signs of concerning diseases.

  5. Cara Toms Says:

    I really enjoyed this article and thought it was helpful even for myself, as I struggle with sleeping most nights. I appreciated the sleep hygiene tips you gave. It is crazy what the brain can do and be trained to do or think, which can surpass all benefits of drug. I believe God created us to be amazing creatures. I also believe sleep to be one of the most important ways to keep healthy. Sleep is a time for the body to naturally heal itself. When people are not getting adequate sleeping time, it makes sense how they could be more susceptible to sickness. I do know how attractive the drugs like benadryl would be. Especially since they are so quick to work and make one feel tired. However, I am not sure how that would benefit them long term and would actually be skeptical to advise a patient to take a sleeping med long term. I agree pharmacists and all other medical professionals should be involved in helping patients deal with sleep. Sleep is too important for the body’s natural function to be ignored.

  6. Heather E. Says:

    I did not realize about one third of Americans experiences insomnia. Very interesting problem that I am glad you addressed. Our healthcare system should put more emphasis on this issue. One aspect of your article I do not think Americans know much information about is sleep hygiene. Knowing these proper sleeping habits could improve the quality of life for many of our patients.

Leave a Reply