How pharmacists can help stem insomnia — a growing public health issue
Thursday, September 03, 2020
Sleeping well not only boosts one’s mood and ability to pay attention, it supports the body's immune functioning and ability to fight infections. So it’s ironic that now when people most need the benefits of a good night’s sleep, an increased number are finding it elusive. In fact, insomnia has surged to such a degree since the pandemic started, that doctors have coined the phrase “COVID-somnia” to describe it.
The following stats illustrate the phenomenon.
One study showed a 37% increase in the rates of clinical insomnia at the peak of COVID-19 pandemic as compared to prior for a sample of over 5,600 adults living in China.
By March 15, prescriptions filled for sleep disorders had already increased by 14.8% compared with the same month-long period in 2019, according to an article in NeurologyToday that got its numbers from a report from the pharmacy benefits manager, Express Scripts.
The magnitude and ongoing uncertainty of the pandemic makes some sleep experts worry that sleep disorders could reach levels approaching a public health crisis in its own right.
The increase in sleep disorders may outlast the pandemic
Medical practitioners speak to the severity of the problem.
“The proportion of our patients who have complaints of insomnia and hypersomnia has increased dramatically since the beginning of this pandemic,” said Alon Avidan, M.D., professor of neurology at UCLA and director of the UCLA Sleep Disorders Center, in NeurologyToday.
Dr. Rachel Marie Salas, associate professor of neurology at the Johns Hopkins Center for Sleep, continues by outlining what is triggering the interrupted sleep patterns all her patients are experiencing. Among the reasons are fears about getting the virus, concerns about loved ones, not being able to go to work and a lack of social contact.
“Some of them now meet the diagnostic criteria for chronic insomnia: not being able to fall asleep within 30 minutes more than three times a week for more than three months,” Dr. Salas said in the article. “They get into bed, the brain kicks in, they start worrying if they're going to lose their job, if their family member is going to survive, and they literally cannot fall asleep.”
Direct links between COVID-19 and sleep may even exist.
“This is not well set science at this point,” said Russell Rosenberg, Ph.D., chief science offer and chief executive officer of NeuroTrials Research of Atlanta, in an article in Physician’s Weekly. “But there is some emerging information that even though Covid-19 may be predominantly a respiratory illness, it is possible that it also affects the brain and then affects sleep.
Unfortunately, individuals who develop sleep disturbances during COVID-19 may be at greater risk for long-term adverse outcomes, explain Canadian researchers in Sleep Medicine. They fear that insomnia and nightmares may persist well after the pandemic and note that such problems are often precursors of psychiatric disorders.
“The high rates of acute insomnia associated with this pandemic, and the evidence that acute insomnia often turns into chronic insomnia, calls for concerted public health interventions notes Julie Carrier, a psychology professor at the University of Montreal and the scientific director of Sleep On It, a national campaign in Canada.
Alternative behavioral therapies or pharma solutions
In light of growing numbers of patients suffering sleep disturbances, the Pharmaceutical Journal recently published an in-depth article on management strategies to help pharmacists better counsel these people.
Their knowledge and experience with both pharmaceutical and alternative therapies uniquely position pharmacists to help mitigate the insomnia crisis. United with other frontline medical professionals, they can address the issue individually and on a community education level.
Currently there’s a culture shift away from hypnotics and towards cognitive behavioral therapy for insomnia (CBT-I) as a first-line intervention, note the article authors. They describe the following five evidence-based, non-pharmacological therapies in detail to help pharmacists develop a greater awareness of treatment alternatives.
- Sleep education and hygiene
- Stimulus control
- Psychoeducation and relaxation strategies
- Sleep scheduling
- Cognitive therapy
“By providing CBT-I advice as a first-line treatment option, pharmacists may negate the need for a hypnotic prescription, reduce drug spend, prevent side effects from medicines and potentially improve treatment outcomes.”
In the NeurologyToday article, neurologists also concede that for many in their profession, the quickest response to complaints of insomnia may be writing a prescription for zolpidem or one of the benzodiazepines. The downside is that these medicines are inappropriate when a patient’s condition has become chronic, as is the case with many COVID-somnia sufferers.
Recent findings justify the effort on the part of healthcare providers to find alternatives.
“In the long-term, they affect your sleep quality and your cognition,” said Mark Boulos, MD, assistant professor of neurology at the University of Toronto. “They also reduce slow-wave sleep.”
Yet it’s when patients still suffer significant distress and daytime symptoms after trying CBT-I and improved sleep habits, hygiene and other therapies that the pharmacist may consider discussing pharmacological treatment with the patient’s prescriber.
The value pharmacists provide by helping people navigate the options to find the way to a better night’s sleep that works for them personally can’t be overemphasized — especially in times like these.
In the words of Charles M. Morin, professor in the psychology department at Laval University, “Sleeping well enhances our psychological and physical resilience and allows us to better manage stress, anxiety and uncertainty in a crisis situation like the one we are currently experiencing.”
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