Page 42 - Demo

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Many herbal medicines are marketed to assist with sleep including valerian, passionflower, lavender, St John’s wort, chamomile, hops, and kava. There have been very few clinical trials investigating the efficacy of herbal medicines for insomnia, and the current evidence of efficacy is inconclusive.4
When should I be referred to the general
practitioner (GP)?
When non-pharmacological treatment options such as sleep hygiene are ineffective and/or over-the- counter (OTC) sleeping medicines are ineffective
or inappropriate, then referral to a GP is required.
If someone wakes from sleep with breathing difficulties, is experiencing insomnia due to another illness such as chronic pain, or snores to an extent where they wake themselves or another up, these are other reasons to consider referral.1
If appropriate, GPs may consider prescribing hypnotic medicines to assist with sleep. When medicines such as benzodiazepines are prescribed their use is ideal for short-term use. If a person experiences a mental illness, or is a candidate for cognitive behavioural therapy for sleep, the GP may consider referral to a psychologist.3,8
Many pharmacies offer sleep apnoea services in Australia. Obstructive sleep apnoea can be another cause of insomnia and non-refreshing sleep. Some pharmacies can provide screening services for apnoea if suitably trained.2
What else can I do?
In addition to the non-pharmacological and pharmacological treatment options for insomnia, there are a number of strategies that can be used to assist.
Sleep diaries, like that provided by the NPS MedicineWise can help people record their sleep and waking patterns, sleep quality, and any activities that may be causing problems.11,12
Finding strategies that help relax people before sleep may be beneficial. Some people find meditation, mindfulness activities, breathing exercises and keeping a notepad next to the bed to write down worries or thoughts so they are not forgotten in the morning can be used.13
For people looking at bright screens late into the evening (e.g. people who work on computers), blue light can interrupt circadian rhythms of melatonin and core body temperature.14 Blue light filter programs can be downloaded onto phones and computers to dull the impact of blue light (e.g. Twilight and f.lux). Orange-tinted glasses can also be worn to block or filter blue light.15
40 Australian Pharmacist January 2017 I ©Pharmaceutical Society of Australia Ltd.
Anna’s insomnia
Anna, a single mother of three, has been experiencing chronic insomnia since a stress-related trigger a couple of years ago. Anna is also taking the antidepressant fluoxetine in the evenings.
While Anna’s insomnia could be due to the night-time fluoxetine dose,
it would be ideal for her to take fluoxetine as a morning dose. This will hopefully reduce her symptoms of insomnia and unrefreshing sleep. As Anna has probably been taking fluoxetine in the evenings for some time, and leads a busy life as a single mother, it may be helpful to recommend a dosing reminder application such as NPS MedicineList+.
If Anna’s symptoms of insomnia do not subside with morning dosing
of fluoxetine, it would be beneficial to discuss some of the non- pharmacological treatment options of insomnia including sleep hygiene measures. As Anna has been suffering from insomnia for some time, encouraging her to discuss this with her GP may also prompt referral to
a psychologist for cognitive behavioural therapy, or short-term use of a hypnotic medicine. Anna’s GP may also change her current antidepressant medicine to an alternative if it is perceived to be ineffective. However, Anna may be concerned about taking hypnotic medicines, as she may not be as responsive to her children if needed overnight. In this case, Anna may prefer non-pharmacological alternatives if changing the dose timing of her SSRI is ineffective.