Relevant News for Pharmacists Regarding the Risks of Sleep Deprivation and Chronic Disease
If you simply put OTC sleeping aids on your pharmacy shelf and haven’t dedicated much time to marketing compounded options—or offering your expertise to help patients—this is the time to take action. National Sleep Awareness falls in March, which means an increase in public service announcements to draw your patient’s attention. Considering one-third of adults sleep for fewer than seven hours, and the connection between sleep deprivation and chronic disease and pain, pharmacists who take the lead can significantly affect a large number of individuals.
Recommended Sleep Duration per Age Group
With an estimated 18 percent of adults and 90 percent of teens getting fewer than six hours of sleep each night, there’s little doubt that many sleepy patients visit your pharmacy seeking OTC sleep aids.1 The latest guidelines recommend that adults sleep seven to nine hours nightly up until the age of 65, then optimal sleep duration is shortened by an hour. Short-sleeping teens are more deprived because they need eight to 10 hours of shut-eye every night—an amount they are likely not getting.
When concerned parents approach your counter with questions about their younger children, you can assess the potential problem based on the National Sleep Foundation’s age-specific sleep duration guidelines:2
- Newborns – 0 to 3 months – 14 to 17 hours
- Infants – 4 to 11 months – 12 to 15 hours
- Toddlers – 1 to 2 years old – 11 to 14 hours
- Preschoolers – 3 to 5 years – 10 to 13 hours
- School-age kids – 6 to 13 years – 9 to 11 hours
Beyond sleep duration, take a few minutes to assess for more serious health concerns. The Berlin Questionnaire is a short 10-question survey that determines the risk for obstructive sleep apnea. Another simple tool—the 8-question Epworth Sleepiness Scale—measures sleep latency, providing a quick but reliable picture of the patient’s degree of sleep deprivation. A high score on the Epworth scale indicates potential narcolepsy.3
Recent News on Sleep Deprivation and Chronic Disease
Sleep deprivation and chronic disease go hand-in-hand. Sleeping less than seven hours per night is associated with a higher risk for:
- high blood pressure
- coronary heart disease
- All-cause mortality
Recent studies highlight new associations between sleep deprivation and health conditions. Some intriguing lines of research include:
- Impact of fiber, fat and sugar: While studies report consistent associations between sleep deprivation and higher total energy intake, a study published in January 2016 took it a step further to look at how food affected sleep. Eating more fiber was associated with increased time spent in deep sleep, while consuming excessive saturated fats predicted lower quality sleep. Diet filled with extra sugar were associated with more arousals from sleep.4
- Veterans at risk: You may be surprised to learn that sleep problems represent the most common health issue in the military—ranking above post-traumatic stress disorder. Veterans with mild traumatic brain injury are especially vulnerable. Ninety-seven percent have some type of sleep disorder. While they frequently report insomnia, 50 percent experience fragmented sleep, and 34 percent have sleep apnea.5
- Emotional imbalance: Many people feel cranky when they don’t get a good night’s sleep, but their mood may come from more than sluggish brain function. Researchers at Tel Aviv University reported that sleep-deprived subjects weren’t able to discern emotional images from neutral images, compared to well-rested participants who only responded to negative emotional images. Just one night without sleep elicited changes in the emotional specificity of the amygdala, which may lead to poor judgment and anxiety.6
Assessment and Treatment to Promote Optimal Sleep
Whether patients approach you to ask about sleeping aids or you actively reach out, compounding pharmacists are often the first point of contact. It’s natural to begin by screening for medications that can interfere with sleep, such as beta blockers, corticosteroids, stimulants, decongestants and narcotic analgesics, but this discussion must include multiple factors that influence quality of sleep:
- Sleep hygiene: Uncomfortable temperatures, interruptions from pets and children, consumption of caffeine and alcohol, and eating too much right before bed are some of the most common causes of sleep problems. Patients may have heard that they should shut down electronics, but ignore the advice because they don’t know that it only takes light from a cell phone to affect circadian rhythms. Adjusting sleep hygiene is the first step to take.
- Underlying chronic disease: Health conditions marked by chronic pain and difficulty breathing, such as arthritis and COPD, are key causes of sleep deprivation. Ask patients if they experience gastroesophageal reflux flare-ups at night. Also asses for heart disease and thyroid problems in patients with a history of sleep problems.
- Psychiatric conditions: Experts used to think that treating depression resolved insomnia, but in some patients, insomnia persists and subsequently precipitates a relapse. Cognitive behavioral therapy combined with medication yields the best results.
From benzodiazepines to dual orexin receptor antagonists, numerous prescription options exist for your patients who can’t fall asleep or struggle to stay sleeping long enough to get a restorative rest. But it’s important to intervene at the check-out when they purchase OTC products, even if it’s just a few words to warn about side effects while handing out an informative brochure and letting them know the you’re available to answer questions. Keep these tips in mind when you have the opportunity to reach out:
- OTC antihistamines: Even though many patients opt for OTC antihistamines, they’re not recommended for long-term treatment of sleep disorders. Even if they’re effective for a few nights, patients can develop tolerance. Sleep-deprived patients won’t pay attention to warnings on the box about side effects and proper use of the product.7
- Off-label treatments: In spite of their off-label use, sedating antidepressants such as amitriptyline are some of the most frequently prescribed treatments for insomnia.8 The American Academy of Sleep Medicine recommends off-label hypnotics when FDA-approved drugs aren’t effective—which happens in about 40 percent of insomniacs.
- Compounded pharmaceuticals: Whether you use pre-mixed supplements containing melatonin, gamma-aminobutyric acid or you need bulk APIs to mix multiple meds, compounded treatments provide optimal benefits for patients, especially if they suffer from sleep deprivation and chronic disease.
Sleep Deprivation Represents a Significant Group of Patients
While protecting your patient’s health by offering the best treatment for sleep deprivation and chronic disease is your top priority, it’s good to know that time spent in patient counseling stands to benefit the health of your business. So here’s a motivating statistic: The top 10 OTC sleeping aids in April 2015 represents $220 million in annual sales. Tapping into a small amount of that market—and diverting some of it to compounded options—will support your bottom line.
Pharmaceutica North America provides OTC sleeping aids and the bulk APIs you need to provide optimal treatments for your patients. Contact us today to discuss our innovative research, quality medications and unique delivery systems.
- “2010 Sleep in America Poll,” March 2010, https://sleepfoundation.org/sites/default/files/nsaw/NSF%20Sleep%20in%20%20America%20Poll%20-%20Summary%20of%20Findings%20.pdf ↩
- “News You Can Use: Sleep Recommendations,” March 2016, http://pharmacytoday.org/article/S1042-0991%2816%2900331-5/fulltext ↩
- “Evaluation of Sleep Disorders in the Primary Care Setting: History Taking Compared to Questionnaires,” February 2011, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041630/ ↩
- What You Eat Can Influence How You Sleep, January 2016, https://www.sciencedaily.com/releases/2016/01/160114213443.htm ↩
- “How Pharmacists Can Combat the Military’s Top Health Problem,” September 2015, http://www.pharmacytimes.com/news/how-pharmacists-can-combat-the-militarys-top-health-problem ↩
- “Lack of Sleep Tampers with Your Emotions,” December 2015, https://www.sciencedaily.com/releases/2015/12/151208133618.htm ↩
- “Five Drug Classes for Sleep Disorders,” January 2016, http://www.pharmacytimes.com/contributor/uri-anderson-pharmd-candidate-2016/2016/01/5-drug-classes-for-sleep-disorders ↩
- “Pharmacotherapy Treatment Options for Insomnia: A Primer for Clinicians,” January 2016, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4730295/ ↩