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Self Care Pharmacy Blog

Posts Tagged ‘insomnia’

 

Poised Poses for more Z’s

Monday, November 17th, 2014

by Rachel Bull, PharmD student

Poor sleep quality is one of the most common health complaints in older adults today.  It is approximated that more than 80% of older adults experience sleep disturbance to some degree, while 50% note the common recurrence of sleep disturbance.1 Insomnia can be defined as, “having trouble falling or staying asleep, waking up too early and cannot return to sleep, or not feeling refreshed after sleeping”.2 The identification of the presence of insomnia is often quite obvious while the cause of the insomnia can be more difficult to identify.  The cause of insomnia can range greatly and is often not the primary disorder rather a response to an underlying issue.  The most common causes of insomnia are stress and anxiety.  Other causes can include a medical illness, poor sleep habits, or other sleep disorders such as sleep apnea and narcolepsy. The standard of care for insomnia is the practice of reestablishing a normal sleep cycle which can be accomplished with sleep hygiene practices such as exercise, a nonprescription sleep aid, or a prescription sleep aid.2 These treatments still pose barriers such as not being completely effective for all patients, therefore alternative treatments for insomnia are still being pursued.  Also, many over the counter sleep aids come with barriers of their own including the body building tolerance against antihistamines which are commonly found in these sleep aids, feeling groggy or unwell the next day, potential medication interactions, and a list of side effects associated with each sleep aid such as dizziness, dry mouth, and daytime sleepiness being the most common among all sleep aids.3 Recently an up and coming trend for treating insomnia has been focused on using the practice of yoga.  Yoga has been found to naturally strengthen the body by improving physical strength and flexibility, reducing stress, improving breathing patterns, and enhancing mental focus.4

A recent publication in Alternative Therapies by Health & Medicine explored the effects of yoga as a treatment for insomnia.1 Alternative therapies, such as yoga, have been proposed to be a safe alternative from the standard of care such as sleep aids and provide a treatment with little adverse events.  This waiting-list controlled trial study was conducted at Shaare Zedek Medical Center in Jerusalem, Israel and looked at how participating in yoga classes twice weekly as well as recommended home-based practices would affect older adults with complaints about insomnia.  The study included 67 participants who were 60 years and older. Sixteen of the participants were assigned to the waiting list control group while the other 43 participants were assigned to the yoga intervention group and 7 participants dropped out for various reasons.  The results concluded that overall the practice of yoga by older adults was shown to be a safe treatment and led to improved sleep quality and duration.  The study found that just 25 minutes of yoga per day for 12 weeks led to improved sleep status. A limitation presented by the authors was that there was not a single method of measuring the outcomes instead a wide range of measuring methods were used.  Another limitation would be the compliance of the participants throughout the study. This was evident with only 10% of participants maintaining the practice compliance level.1

There has been previous research done on this topic over the years. Another study showed yoga can positively affect insomnia by improving sleep efficiency and sleep duration.4 The study provided the participants with yoga training and instructed all participants to maintain daily yoga practice for eight weeks.  The participants kept sleep diaries for two weeks before the yoga practices began and for the entire eight week study to record the amount time spent asleep, number of times they woke up during the night, and the time spent sleeping between waking periods.  The study also noted that the cause of insomnia has commonly been linked to anxiety and depression.4 Another study published in the Indian Journal of Psychiatry found that 60 minutes of yoga daily for 6 months led to improved sleep quality among the elderly aged 60 years and older.5 This study supports the conclusion that the practice of yoga improves sleep quality while noting that further research should be conducted on this alternative therapy because of its great potential to treat insomnia.5

Yoga still offers barriers such as potential injury and the fact that the elderly population should not first attempt yoga on their own without seeking advice from their primary care provider. On the other hand, yoga can be more financially friendly than some medications offered to treat insomnia.  The benefits of yoga naturally target the most common causes of insomnia, which prove to be another reason why the practice of yoga should be utilized as a treatment for insomnia. Yoga can easily be incorporated into a basic lifestyle change by finding a yoga class at a local gym or fitness center or in the peace of your own home by using instructed yoga videos for just 30 minutes a day.

Are these poised poses worth a try? Do you think specifically yoga treats insomnia or simply exercise in general?  Is yoga the answer to your sleepless nights?

 References

  1. Baharav A, Cahan C, Cohen M, Halpern J, Kennedy G, Reece J. Yoga for improving sleep quality and quality of life for older adults. 2014; 20(3):37-38-46.
  2. 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.
  3. Mayo Clinic Staff. Sleep aids: Understand over-the-counter options. Mayo Clinic Web site. http://www.mayoclinic.org/healthy-living/adult-health/in-depth/sleep-aids/art-20047860. Published 12/10/2011. Updated 2014. Accessed 11/15, 2014.
  4. Khalsa, SBS. Treatment of Chronic Insomnia with Yoga: A Preliminary Study with Sleep-Wake Diaries. 2004; 29(4):269-278.
  5. Basavaraddi IV, Gangadhar BN, Hariprasad VR, et al. Effects of yoga intervention on sleep and quality-of-life in elderly: A randomized controlled trial. 2013; 55:364-365-368.

Insomnia: Not just about sleep

Monday, 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.