How primary care physicians can help adults get more sleep

Physicians need to inform their patients about sleep and the importance of making sleep a top health priority, according to the president of the American Academy of Sleep Medicine.

According to a recent study from the CDC, more than one third of American adults are not getting enough sleep each night. The American Academy of Sleep Medicine (AASM) and the Sleep Research Society released a joint statement in 2015 recommending that adults aged 18 to 60 years sleep 7 or more hours per night on a regular basis.

In various reports, the CDC has classified insufficient sleep as a "public health problem" due to its widespread impact.

"Sleep impairment is linked as a contributing factor to motor vehicle crashes, industrial disasters, and medical and other occupational errors," the agency wrote in Morbidity and Mortality Weekly Report in 2011. "Persons experiencing sleep insufficiency are more likely to have chronic diseases such as cardiovascular disease, diabetes, depression or obesity. In 2008, approximately 28% of surveyed adults in the United States reported frequent insufficient sleep, which has been associated with fair/poor general health, frequent mental and physical distress, depressive symptoms, anxiety and pain."

Physician assessment

Nathaniel F. Watson, MD, MSc, president of the AASM, told Healio Internal Medicine that patients often neglect to discuss problems with sleep unless their doctor raises the issue.

"Physicians are encouraged to make the topic of sleep an essential part of routine conversations with patients," he said. "You can open the door to this conversation by asking a simple, open-ended question such as, “How is your sleep?” Depending on the response, a good follow-up question might be, “How many hours of sleep do you get on a typical night?”"

Watson said that physicians can use the Epworth Sleepiness Scale to measure patients' levels of daytime sleepiness, which can indicate a chronic sleep problem, and the STOP-Bang questionnaire to assess sleep apnea risk. Wearable technology may also help physicians evaluate sleep behaviors.

"Today many patients use wearable devices such as Fitbit and Jawbone to track their sleep," he said. "Although these consumer devices provide inaccurate estimates of actual sleep times, they can provide useful, real-world data to help clinicians better understand their patient's sleep habits, such as their typical bedtime and wake time."

Improving sleep

Watson said that physicians can help encourage patients in improving their sleep health by suggesting they go to bed early enough to get at least 7 hours of sleep.

"Bedtime procrastination is a problem for many patients, especially since mobile devices provide the constant temptation of entertainment, distraction and social engagement," he explained. "Physicians can encourage patients to set a technology curfew an hour before bedtime, schedule a bedtime alarm as a reminder to get ready for sleep, and remove technological devices from the bedroom."

Several organizations stated that health care providers can help improve healthy sleep habits by routinely assessing patients' sleep hygiene and by counseling patients about the importance of healthy sleep, especially patients with comorbid chronic diseases.

"As a nation we are not getting enough sleep," Wayne Giles, MD, director of CDC's Division of Population Health, said in a press release. "Lifestyle changes such as going to bed at the same time each night; rising at the same time each morning; and turning off or removing televisions, computers, mobile devices from the bedroom, can help people get the healthy sleep they need."

The CDC reported that physicians can also recommend behavioral changes that are effective in promoting good sleep habits, which include:

avoiding stimulating activities such as exercise 2 hours before bedtime;
keeping a regular sleep schedule;
abstaining from going to bed with an empty or full stomach;
refraining from using alcohol, caffeine or nicotine at night; and
sleeping in a room that is dark, quiet, well-ventilated with an agreeable temperature.

Referral and follow-up

Physicians should refer to a sleep specialist if patients complain of persisting sleep problems, especially if they experience daytime symptoms, or if patients present with extreme anxiety or frustration associated with their sleep quality, Watson said.

"Patients who are at risk for obstructive sleep apnea should be referred to a sleep physician for a comprehensive evaluation, which may include diagnostic testing by overnight polysomnography or home sleep apnea testing," he said. "Referral to a sleep specialist also should be considered for any patient who describes undesirable physical events during sleep, such as sleepwalking or dream enactment, especially if the behaviors are potentially injurious to the sleeper or a bed partner."

Watson cautioned that, as most sleep disorders are chronic in nature, they require coordinated care, long-term management and ongoing follow-up.

"Primary care providers should routinely ask sleep disorders patients about treatment adherence, and patients who fail to adhere to the prescribed treatment should be referred back to the sleep specialist for additional assistance," he said. – by Chelsea Frajerman Pardes

Reference:

CDC. MMWR Morb Mortal Wkly Rep. 2011;60(8):239-242.