Provide Patients With Self- Management Strategies for Insomnia

Achieving sufficient restful sleep and maintaining a regular sleep schedule are crucial for overall health, just like maintaining a nutritious diet and regular exercise program. Studies indicate that insufficient, disrupted sleep negatively impacts cognitive functions such as attention, learning, and memory, as well as physical and mental health.

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The National Heart, Lung, and Blood Institute highlights that sleep deficiency and untreated sleep disorders are associated with a rising incidence and prevalence of various chronic health conditions, including cardiovascular disease, hypertension, stroke, diabetes, obesity, and certain cancers.¹ The Figure² shows the clinical benefits of a healthy sleep pattern, according to the Sleep Foundation.

Although everyone experiences sleep issues occasionally, many individuals in the US experience insomnia regularly. Insomnia involves trouble either falling asleep or staying asleep, or periodically waking up earlier than desired despite permitting adequate time in bed for sleep. Symptoms of insomnia include daytime fatigue; sleep dissatisfaction; difficulty concentrating; and feelings of depression, anxiety, or irritability.³ It can be acute or chronic and significantly impacts health and quality of life, leading to decreased productivity; higher accident risks; and increased irritability, anxiety, and daytime fatigue.⁴ The American Academy of Sleep Medicine indicates that chronic insomnia can be damaging to physical, mental, and emotional health, negatively affecting overall wellness and daily functioning. Additionally, chronic insomnia can lead to augmented risks for depression, anxiety, substance abuse, work-related accidents, Alzheimer disease, and type 2 diabetes.³

News and Recent Clinical Data About Sleep and Insomnia

According to a recent survey conducted by the American Academy of Sleep Medicine, 12% of Americans struggle with chronic insomnia. The online survey was conducted between May 16 and 24, 2024, involving 2006 adults. The results revealed that men were marginally more likely to have been diagnosed with chronic insomnia than women, with the most prevalent rates of diagnosis noted among individuals aged 25 to 44 years.⁵

In May 2024, the National Sleep Foundation published a consensus statement that included a comprehensive review of the current evidence on the impact of screen use on sleep health across different age groups. The consensus statement said screen use generally disrupts sleep health in children and adolescents, primarily when digital devices are used before bedtime. The panel of experts also noted that behavioral strategies and interventions could help diminish these adverse effects, such as limiting screen time and teaching children about technology use and its impact on sleep.⁶

A study published in BMJ Open Sport & Exercise Medicine revealed that breaks in the evening for body weight resistance exercise activity have the potential to improve sleep periods and total sleep time.⁷ Specifically, the study data showed that interrupting sedentary time every 30 minutes in the evenings with 3 minutes of lightto moderate-intensity body weight resistance exercises extended free-living time spent asleep by 27 minutes. It also had no disruptive effects on other sleep elements and 24-hour physical activity patterns in its healthy adult participants.⁷

A study in Diabetologia revealed that unhealthy sleep patterns, whether too little or too much, meaningfully increase the risk of type 2 diabetes in a diverse adult population.⁸ The investigators evaluated long-term trajectories of sleep duration and incident diabetes in 22,285 Black adults and 13,737 White adults. The analyses showed that most suboptimal sleep trajectories were consistently correlated with incident diabetes across all sociodemographic subgroups.⁸

Nonprescription Sleep Aids

The primary objectives in treating insomnia are to detect and address any underlying causes when possible and to enhance the patient’s quality of sleep, daytime functioning, and productivity. The use of OTC sleep aids is often the first line of treatment for insomnia. These products are available in a variety of dosage formulations and typically contain either diphenhydramine or doxylamine, although some products contain melatonin and other herbal supplements for sleep.⁹ OTC sleep aids are not indicated for patients who have chronic insomnia, for whom a medical referral is recommended.⁹

Pharmacists are well positioned to ascertain the appropriateness of self-treatment strategies and can guide patients in adequately deciding on the suitable agent. One important role is screening for possible therapeutic duplications (diphenhydramine can also be found in some cold and allergy medications) or drug-drug interactions and contraindications and directing patients to seek further medical evaluation from their primary health care provider. Self-treatment can sometimes be inappropriate, particularly in pediatric patients, older adults, and those with chronic comorbidities who are taking other medications.

Pharmacists can also assess patients and identify specific medical conditions, such as arthritis, heartburn, hyperthyroidism, and sleep apnea, which may impact or disrupt the quality and duration of sleep. Pharmacists should also identify pharmacological agents such as antidepressants, antihypertensives, and sympathomimetic amines that are commonly associated with insomnia and make patient-centered clinical recommendations accordingly.⁹

Recommendations

Pharmacists should advise patients that nonprescription sleep aids are indicated only for short-term use, and if insomnia continues or exacerbates after 7 to 10 days of using these agents, patients should consult their primary health care provider for further guidance.⁹ Patients should also be instructed to adhere to the manufacturers’ recommended dosage and duration of treatment and be aware of potential adverse drug reactions such as morning grogginess, xerostomia, constipation, and blurred vision, as well as drug interactions and warnings. Pharmacists can also remind patients that to enhance sleep, establishing a regular bedtime routine, limiting naps to 20 to 30 minutes, avoiding heavy meals and stimulants before bed, discontinuing electronic device use before bedtime, and creating a relaxing sleep environment can be advantageous. Through effective patient education initiatives, pharmacists can be instrumental in treating insomnia by advising patients, recommending available treatments, monitoring adverse drug reactions, promoting sleep hygiene, and encouraging further medical evaluations when appropriate.

REFERENCES

1. Sleep science and sleep disorders. National Heart, Lung, and Blood Institute. Accessed August 2, 2024. https://www.nhlbi.nih.gov/science/sleep-science-and-sleep-disorders

2. Summer J, Singh A. 8 health benefits of sleep. Sleep Foundation. Updated February 29, 2024. Accessed August 2, 2024. https://www.sleepfoundation.org/how-sleep-works/benefits-of-sleep

3. Survey shows 12% of Americans have been diagnosed with chronic insomnia. News release. American Academy of Sleep Medicine. June 14, 2024. Accessed August 2, 2024. https://aasm.org/survey-shows-12-of-americans-have-been-diagnosed-with-chronic-insomnia/

4. Kaur H, Spurling BC, Bollu PC. Chronic insomnia . In: StatPearls. StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK526136/

5. AASM sleep prioritization survey: chronic insomnia. American Academy of Sleep Medicine. 2024. Accessed August 2, 2024. https://aasm.org/wp-content/uploads/2024/06/sleep-prioritization-survey-2024-chronic-insomnia.pdf

6. Hartstein LE, Mathew GM, Reichenberger DA, et al. The impact of screen use on sleep health across the lifespan: a National Sleep Foundation consensus statement. Sleep Health. 2024;10(4):373-384. doi:10.1016/j.sleh.2024.05.001

7. Gale JT, Haszard JJ, Wei DL, Taylor RW, Peddie MC. Evening regular activity breaks extend subsequent free-living sleep time in healthy adults: a randomised crossover trial. BMJ Open Sport Exerc Med. 2024;10(3):e001774. doi:10.1136/bmjsem-2023-001774

8. Xiao Q, Full KM, Rutter MK, Lipworth L. Long-term trajectories of sleep duration are associated with incident diabetes in middle-to-older-aged Black and White Americans. Diabetologia. Published online June 27, 2024. doi:10.1007/s00125-024-06202-8

9. Eisenhower C. Insomnia, drowsiness, and fatigue. In: Krinsky DL, Ferreri SP, Hemstreet BA, Hume AL, Newton GD, Rollins CJ, Tietze KJ, eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. American Pharmacists Association; 2020.