The Role of the Pharmacist in Treating Insomnia

Joshua J. Pray, PharmD Candidate, W. Steven Pray, PhD, RPh

US Pharmacist. 2003;28(7) 

In This Article

Introduction

The pharmacist is the primary point of contact for people who require assistance with minor health conditions that can be treated with self-care products. Generally, these minor conditions do not cause long-lasting effects and are self-limited. However, insomnia is markedly different. This disorder affects many facets of life and can be harmful because of its ability to cause a residual daytime sleepiness. For this reason, it is vital for the pharmacist to understand insomnia and its sequelae.

The lay public thinks of insomnia as a total inability to sleep, perhaps for months at a time. Investigators have attempted to clarify the parameters of insomnia to facilitate its diagnosis. In one study, investigators reviewed psychology trials extending back for two decades to establish defensible criteria for insomnia.[1] They concluded that insomnia is best defined as the inability to sleep for 30 or more minutes after attempting to do so (known as the "sleep latency" interval), occurring on three or more nights per week, and lasting for six or more months. The definition of insomnia is clouded because it is dependent on the patient's estimation of his or her sleep efficiency, which may not be entirely accurate. Researchers attempted to discover whether patients with insomnia could reliably detect whether they were asleep or awake by comparing diaries to polysomnograph readings.[2] They discovered that insomniacs have a reduced ability to discriminate sleeping from being awake and are prone to misclassify a sleeping episode as one in which they were awake. Thus, insomniacs may greatly overestimate the extent and duration of insomnia.

Primary insomnia is not induced by disease but is a result of a combination of psychological and/or social factors. On the other hand, secondary insomnia is caused by a disease process, underlying medical disorder, or external substance (eg, medications, alcohol). This review will discuss both types of insomnia.

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