Help Patients Prevent and Reduce Insomnia

Insomnia is one of the most common conditions for which patients seek medical care, and its effects vary in terms of duration and severity.

The most recent statistics from the Sleep Foundation indicate that between 10% and 30% of adults experience frequent insomnia, including between 30% and 48% of older adults.¹

Approximately one-third of adults in the United States occasionally experience insomnia. Ten percent to 15% report problems with functioning during the daytime, and 6% to 10% have symptoms severe enough to meet the criteria for an insomnia disorder, according to the American Psychiatric Association.²

The Sleep Foundation classifies insomnia into 2 main types:

• Chronic: long-term patterns of sleep issues. Patients have challenges falling asleep or staying asleep. Insomnia symptoms occur at least 3 times per week and persist for at least 3 months.³
• Short-term (acute or adjustment insomnia): often caused by prolonged anxiety or stress over the death of a loved one, financial problems, job loss, or relationship changes. This type may last for days or weeks, typically for fewer than 3 months; it can occur in adults and children and frequently occurs during menopause and pregnancy.³

Chronic insomnia can adversely affect academic performance, health, and quality of life. It can cause irritability and daytime sleepiness, decreases work productivity, and increases the risk of motor vehicle accidents. Statistics show that just 5% of individuals with chronic insomnia sought care from their primary care physician, specifically for insomnia, and just 26% of those patients discussed insomnia during a visit for another medical issue.⁴

Factors contributing to insomnia can be classified as environmental, physical, or psychological and include the following⁵:

• Anxiety, depression, stress, and other mental health issues
• Life stressors, such as financial and job worries
• Changes in environment, routine, or schedule
• Medical conditions, such as chronic pain, congestive heart failure, gastroesophageal reflux disease, hormone fluctuations, hyperthyroidism, nocturia, obstructive sleep apnea, respiratory disorders, and restless legs syndrome
• Use of alcohol, caffeine, and nicotine

Recent Clinical Publications and Product News

Nature’s Bounty recently announced its new line of jelly bean supplements, including Sleep Jelly Beans that contain melatonin.

In a recent study, investigators surveyed health care professionals in specialties considered to put them at high risk for exposure to COVID-19.

The investigators found that longer sleep duration was linked to lower odds of COVID-19 and that greater burnout and other factors were strongly correlated with greater odds of contracting COVID-19. They also found that for each additional hour of sleep at night, the risk of contracting COVID-19 plummeted by 12% in the study population of frontline health care practitioners. Further, those who reported experiencing work-related burnout every day were 2.6 times more likely to report having COVID-19, have it for a longer time, and experience more severe COVID-19.⁶

The results of a study published in Lancet Psychiatry show that insomnia may be one of the most common neurological and psychiatric outcomes of COVID-19.⁷

In addition, according to results of a randomized clinical trial published in JAMA Psychiatry, cognitive behavioral therapy for insomnia may help thwart major depression among older adults with insomnia disorder.⁸

At the 2021 SLEEP annual meeting, investigators indicated that difficulty getting to sleep had the greatest impact on cognition later in life compared with other symptoms of insomnia.⁹ The findings were published in the journal Sleep.

A recent news story on the Cleveland Clinic website evaluated various OTC sleep aids. The article postulat- ed that after careful patient assessment for appropriateness, the use of OTC sleep aids diphenhydramine and doxylamine and complementary therapies such as melatonin and valerian root may be a helpful short-term remedy for those who experience an occasional sleep issue. The article also recommended other strategies to help resolve insomnia, such as good sleep hygiene, including maintaining a regular bedtime and wake-up routine, as well as avoiding alcohol, electronic devices, stimulants, and tobacco before bedtime. Other strategies recommended included establishing a regular exercise routine, keeping a sleep journal, and seeking advice from a primary health care provider about a drug-free therapy to improve sleep, such as cognitive behavioral therapy for insomnia.¹⁰

During counseling, inform patients that OTC sleep aids are indicated for the treatment of short-term insomnia. Advise them about recommended dosage, duration of use, potential drug interactions, and adverse effects, as well as precautions and warnings. Due to their drug expertise, pharmacists are in a pivotal position to identify those medical conditions or pharmacologic agents that may be correlated with and/or exacerbate episodes of insomnia. Pharmacists can also be instrumental in educating patients about the efficacy and safety of OTC sleep aids, including supplements marketed for sleep health, and recommending nonpharmacological measures to combat insomnia. This will enable patients to make informed decisions regarding the management and treatment of insomnia. Moreover, pharmacists can encourage patients experiencing chronic insomnia and/or those with preexisting medical conditions to seek further medical evaluation from their primary health care providers when warranted. The CDC website offers several valuable patient education resources about insomnia.¹¹

Yvette C. Terrie, BSPharm, RPh, is a consulting pharmacist and a medical writer in Haymarket, Virginia.

References

1. Sleep statistics. Sleep Foundation. Updated November 12, 2021. Accessed January 26, 2022. https://www.sleepfoundation.org/how-sleep-works/sleep-facts-statistics

2. What are sleep disorders? American Psychiatric Association. August 2020. Accessed January 26, 2022. https://www.psychiatry.org/ patients-families/sleep-disorders/what-are-sleep-disorders

3. What are the different types of insomnia? Sleep Foundation. Updated June 24, 2021. Accessed January 26, 2022. https://www.sleepfoundation.org/insomnia/types-of-insomnia

4. Chawla J. Insomnia. Medscape. Updated January 27, 2022. Accessed February 21, 2022. https://emedicine.medscape.com/ article/1187829-overview#a6

5. Insomnia. Cleveland Clinic. Updated October 15, 2020. Accessed January 26, 2022. https://my.clevelandclinic.org/health/diseases/12119-insomnia

6. Kim H, Hegde S, LaFiura C, et al. COVID-19 illness in relation to sleep and burnout. BMJ Nutr Prev Health. 2021;4(1):132-139. doi:10.1136/bmjnph-2021-000228

7. Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. Lancet Psychiatry. 2021;8(5):416-427. doi:10.1016/S2215- 0366(21)00084-5

8. Irwin MR, Carrillo C, Sadeghi N, Bjurstrom MF, Breen EC, Olmstead R. Prevention of incident and recurrent major depression in older adults with insomnia: a randomized clinical trial. JAMA Psychiatry. 2022;79(1):33-41. doi:10.1001/jamapsychiatry.2021.3422

9. Zaheed AB, Spira AP, Chervin R, Zahodne L. Insomnia symptoms and subsequent cognitive performance in older adults: are depressive symptoms and vascular disease mediators? Sleep. 2021;44(suppl 2):A212. doi:10.1093/sleep/zsab072.535

10. What to know about over-the-counter sleep aids. Cleveland Clinic. July 1, 2021. Accessed January 26, 2022. https://health.clevelandclinic.org/what-to-know-about-over-the-counter-sleep-aids/

11. Sleep and sleep disorders. CDC. Updated May 4, 2017. Accessed February 21, 2022. https://www.cdc.gov/sleep/resources.html