Topic Team Training – Sleep Disorders

Following on from the March issue Continuing Professional Development on the Management of Sleep Disorders, this 5-Minute Learning Module is designed to enhance the community pharmacy team understanding and ask further questions as to how you can support and advise patients.

is in the pursuit of obtaining over-the-counter medications.

Management of insomnia should include sleep hygiene education to correct the maladaptive behaviours they may have already developed. Pharmacological intervention in the form of non-prescription, over-thecounter sleep aids is widely used in the treatment of acute or shortterm insomnia. It is the decision of the pharmacist to use OTC sleep aids depending on their efficacy and safety based on the currently available data. The dosage and duration of administration should be closely monitored.

Obstructive sleep apnoea syndrome (OSA) is characterised by repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation or brief microarousals from sleep.

movement disorder, and bruxism. Sleep disruption or daytime fatigue/sleepiness is needed for the diagnosis of a sleep- related movement disorder.

Cognitive behavioural therapy for insomnia (CBTi) is a validated non-medication method to treat insomnia and is the first line treatment for chronic insomnia. Pharmacological treatment should be considered if CBTi is unsuccessful or not available or as an adjunct to CBTi.

After completing this module, you should recognise the varying types of sleep disorders that may present to the pharmacy and the OTC treatments available for each. Where pharmacy management is appropriate you will be able to explain to patients the nature of their type of disorder and suggest possible solutions. You will be able to give advice on current recommendations of symptom management and know how to signpost to relevant resources. Where a patient wishes to purchase OTC treatments, you should be able to support that person to make appropriate choices.

Sleep plays a vital role in the maintenance of optimal physical and mental health. Unfortunately, sleep disorders are highly prevalent and approximately 10% of the adult population suffers from insomnia. Several chronic physical and mental health conditions are linked to sleep deprivation and sleep disruption. Sleeping less

Consider: compared to your individual sleep need results in sleep deprivation and if the continuity of sleep is disturbed, it results in poor sleep quality and both sleep deprivation and disruption has daytime consequences. There are multiple factors that can cause sleep disruption and presence of sleep disorders is one of them.

The International classification of sleep disorders – 3rd edition (ICSD – 3) details different categories of sleep disorders and their diagnostic criteria. The most common sleep disorders are insomnia and sleep breathing disorders followed by sleep related movement disorders.

The pharmacist is in a unique position to assist with the assessment and management of acute insomnia since pharmacists are the professionals who are contacted at the beginning of sleep difficulties, often to resolve the sleep difficulty while the individual

 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?

OSA is characterised by loud snoring or brief gasps that alternate with episodes of silence or pauses that usually lasts at least 10 seconds. Patients are usually unaware of the loud snoring and breathing difficulty and it is often the bed partner who reports the difficulty. The patient may recount frequent arousals and brief awakenings that occur throughout the night.

The most reported sleep-related movement disorders are restless legs syndrome (RLS), periodic limb

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 herbal remedies, differ

Pharmacists have an important role in the management of acute insomnia to prevent the progression to chronic insomnia by assessing, providing the sleep hygiene education, and managing the short-term sleep difficulties using over the counter sleep aids as deemed appropriate. Pharmacists can also aid by evaluating the symptoms and advising on the referral pathway to each individual patient.

Additional Resources: Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline.

International classification of sleep disorders – 3rd edition (ICSD – 3)

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.