Sleep: What I wish I’d known
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I’ve been a primary care provider now for 37 years, but I still remember my early days of residency well.
Back in 1985, it made me nervous when a patient shared that they had trouble sleeping, as I was not confident in how to proceed and ensure I was doing the right thing for my patient, in part due to the limited education I received in medical school and residency on sleep — let alone insomnia. I would turn to other physicians for direction, but the best approach for treating a patient with insomnia was really nebulous and unclear to us all. At the time, information about insomnia and research on treatment options were limited, prompting us to rely on medications intended for anxiety and depression, often resulting in unwanted side effects.
Despite the profound impact insomnia has on the nights and days of people with trouble sleeping (PWTS), such as their daily routines, jobs and relationships, patients often don’t share with their providers when they are struggling with insomnia. And if they do, it’s frequently after they’ve already tried to improve their sleep on their own. If I could turn back the clock, I’d wish for a deeper understanding of the science behind insomnia, as well as available treatment options, including the benefits and limitations of sleep hygiene, and what questions to ask patients to get a full picture of their insomnia. This knowledge would have empowered me to feel more confident initiating conversations with my patients about their sleep and treating them effectively.
The impact of insomnia is more urgent now than ever, as we’ve seen rates rise during the COVID-19 pandemic. As the most prevalent sleep/wake disorder, insomnia affects approximately 25 million adults in the U.S. The DSM-5 defines insomnia as a combination of difficulty obtaining sufficient sleep and dissatisfaction with sleep combined with a significant negative impact on daytime functioning for a minimum of 3 nights per week over a period of 3 months. We are continuing to learn the impact that poor quality and/or insufficient sleep caused by insomnia can have on daily lives, including the ability to concentrate, mood and energy levels, as well as more serious health consequences such as depression, cardiovascular disease, type 2 diabetes, dementia and obesity.
To help increase awareness and education around insomnia, I’ve joined The Alliance for Sleep, a multidisciplinary group of fellow sleep experts (sponsored by Idorsia U.S.) that is very focused on advancing research, elevating the standard of care and improving the health and quality of life for those with insomnia. With my own experience as a primary care physician, I can appreciate the importance of providing more education — for health care providers (HCPs) and patients — around the science of insomnia, the impact on the day and the importance of treating insomnia for overall improved patient health.
One of the first initiatives The Alliance for Sleep conducted was the Wake Up America: The Night & Day Impact of Insomnia Survey, the largest U.S. survey of PWTS and HCPs. Results revealed that despite the surplus of available information about sleep, misconceptions about insomnia continue to be believed — both by the general public and our fellow health care communities. Furthermore, results found that PWTS believed or were unsure of falsehoods such as: your body can get used to functioning on less sleep (63%); naps can make up for lost sleep (61%); all prescription sleep medications work the same way (44%); and you can make up for lost sleep another night (43%).
On the HCP side of the same survey, 93% of primary care providers reported that improved sleep hygiene is often the best solution for treating insomnia. I’ve found that my colleagues are frequently surprised that this in fact is not true. According to guidelines from the American Academy of Sleep Medicine, sleep hygiene alone is not an effective treatment for insomnia. Once insomnia has taken hold, it will require more intervention than just sleep hygiene to help your patients. This is one of the reasons I’m continuing to drive education about sleep and insomnia across health care professional communities with The Alliance for Sleep.
As something we spend one-third of our lives doing, I firmly believe as health care professionals we can never be too knowledgeable about sleep. And while the best way we can help our patients is by educating ourselves, it’s also important to take the time in our visits to ask patients about their sleep — including if it is impacting their day.
References:
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Idorsia. https://www.idorsia.com/. Accessed Nov. 5, 2022.
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Wake Up America. https://www.wakeupamericasurvey.com. Accessed Nov. 5, 2022.