Insomnia: Not just about sleepDecember 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?
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.