Topic Team Training – Sleep Disorders

Topic Team Training – Sleep Disorders

A community pharmacy environment that fosters teamwork ensures high levels of consumer satisfaction. This series of articles is designed for you to use as a guide to assist your team in focusing on meeting ongoing CPD targets and to identify any training needs in order to keep the knowledge and skills of you and your team up to date.

The below information, considerations and checklist provide support to enable you to run a team training session and identify opportunities for learning within the topic of Sleep Disorders.

Effects of Sleep Disorders

Early recognition and treatment of common sleep disorders helps to minimise significant health, social and fiscal consequences. Community pharmacy is recognised as a valuable and trusted public health resource within this field.

Insomnia disorder has a prevalence of between 6% and 20%. This increases to between 30% and 48% of the general population at a symptom level. Being older, female, or being from a socioeconomic background are independent risk factors for the development of insomnia. Having a previous episode of insomnia also increases the risk of a future episode.

Three classification systems exists for the definition of insomnia,

International Classification of Diseases (ICD), Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Sleep Disorders (ICSD).

Pharmacological treatment for insomnia should be limited to short term use only, if CBT-I is unavailable or if a patient does not respond to CBT-I. Available substances that are commonly used include benzodiazepines (BZ), benzodiazepine receptor agonists (BZRA), antidepressants, anti-psychotics, antihistamines, phytotherapeutic substances and melatonin. All medications prescribed for sleep disturbances should be monitored carefully and assessed for any emergence of adverse side effects. Patients should always be made aware of potential interactions with other medications and OTC medications they may be prescribed and the possibility of exacerbation of underlying medical conditions.

Restless legs syndrome (RLS) is a neurological sleep disorder. It is also called Willis-Elbom disease (WED). Prevalence of RLS ranges from 0.6% to 15% of the population. This increases to 27% in pregnant females. The disorder is defined by the classic clinical symptoms of an overwhelming urge to move the legs while resting in the evening and night. This is accompanied by an uncomfortable/unpleasant sensation in the legs with patients often describing it as a crawling sensation. Symptoms are partially or totally relieved by walking or stretching the legs.

Obstructive sleep apnea syndrome is the most common respiratory disorder of sleep with a prevalence of at least 4% in the general population, and twice as common in males as females. It is a complex disorder characterised by brief interruptions in breathing which are a result of mechanical factors that increase the collapsibility of the upper airway. The most common associated nocturnal symptoms include snoring, gasping or choking, witnessed apneas, nocturia, frequent awakenings, enuresis and nightmares.

Evidence-based patient questionnaires can be used to help guide the pharmacist as to the nature of the sleep disturbance. Some of the most popular and most beneficial include:

Insomnia Severity Scale (ISS)Epworth Sleepiness Scale (ESS)Stanford Sleepiness Scale (SSS)

RLS Screening Questionnaire (RLSSQ)

STOP and STOP-Bang Questionnaire (STOP)

A starting conversation around sleep can uncover and address any unhealthy sleep practices that may be present. Healthy sleep practices, known as sleep hygiene include limiting caffeine products, structured meal times, exercise, avoiding phone use in the lead up to bedtime and addressing the bedroom environment ensuring its cool, dark, quiet.

Further Assistance: Management of Sleep Disorders Continuing Professional Development Module, Irish Pharmacy News Issue March 2022 – pages 41-44

Consider:

• Am I/my team aware of the licensed indications, maximum recommended duration of treatment, doses and age limitations for OTC products used for the various types of sleep disorders?

• Am I/my team aware of the medicines that can cause some sleep disorders, such as insomnia?

• Am I/my team confident in the difference between types of sleep disorders?

• Are we confident about raising issues of sleep disorders with customers?

Key Points:

Check your pharmacy team are aware and understand the following key points:

• Ensure the pharmacy team knows to be sensitive in dealing with customers who may feel vulnerable as a result of insomnia

• Ensure pharmacy staff understand the function and importance of sleep and what effect a lack of sleep has on overall health

• Ensure we are all aware of how much sleep is enough for different groups of people

• Promote training and education as to the types of sleep disorders and their possible causes

• Educate the pharmacy team on how OTC treatments, including sleep aids and herbal remedies, differ

Actions:

Ensure support staff understand the following key points:

• The common causes of insomnia, including lifestyle issues, medication and conditions that can cause sleep issues

• How to spot sleep disorders and insomnia in both colleagues and customers to get them the help they need

• The benefits and limitations of OTC medicines

• The importance of good sleep hygiene for everyone

• Lifestyle issues that may cause sleep disorders, and tips on improving lifestyle

• The importance of regular food intake and sufficient exercise

• When to refer customers to the pharmacist.