All I want for Christmas is to be able to go to sleep – and then not wake up in the middle of the night…
Part 2 of the 5 part series
In my last Christmassy post, I briefly touched on why sleep matters and then hinted at the ‘Elephant in the room’ of dependency forming sedatives. Yikes.
So, let’s (metaphorically) shoot that elephant!
But, where to begin?
“It is clear that an urgent review of how sedating antihistamines are supplied is needed. Careful consideration will be required to ensure accessibility for those who legitimately use them, whilst restricting use in those deliberately seeking their abuse.”
“How should I manage a person with short-term insomnia (less than 3 months duration)?”
And if we choose to consider ourselves part of Europe… we can add the European Sleep Research Society’s very recently updated (Nov 2023) European Insomnia Guideline. I’ve included the relevant paragraph below:
Therefore, the scientific evidence at this point does not support a recommendation for antihistaminergic drugs in the treatment of insomnia either short or long term. Recently published evidence (Oyekan et al., 2021), indicating an association of antihistamines with increased mortality, suggests further caution.
Which leads me neatly to:
What IS, a feasible for community pharmacy, first-line therapy for insomnia?
Makes me feel like Lord Nelson, who’s cited as saying:
“I see no ships”.
It’s difficult to see the rows of generic and brand name first generation, sedating antihistamines, typically available in community pharmacy.
But evidence-based, first-line therapy for insomnia, isn’t routinely available at the first HCP/patient interaction, in community pharmacy.
Which is frustrating!
The research is there to demonstrate that CBT-I is effective. It would be a fee-paying option to see a sleep practitioner, so that’s not a viable option on cost grounds for some people and basically there are just not enough sleep practitioners to go round anyway.
So, what can you do to help the insomniac?
First get some independent, free, and evidence-based training.
The challenge here is the frustratingly patchy access to NHS digital therapeutics, perhaps a dismissive attitude to an app on a phone, or a private fee-paying sleep practitioner.
The options are…..
A free ‘digital therapeutic’ sleep app for insomnia that has evidence to justify its availability.
While perhaps it’s not the most attractively packaged for 2023/2024, it is available for Android and Apple phones here: https://sleepful.me/
The Sleep Reset
Next up, we have The Sleep Reset – it’s a hybrid of a digital therapeutic with the ability to message “a trained sleep coach” for accountability and support.
Could be an option. But only if they can afford to pay for it.
The BSPSS are currently exploring it.
This is an affiliate link:
If the patient can pay here is where you can find help from a credible source: https://babcp.com/CBTRegister/Search#/
Or you could direct the sufferer to their GP and seek a referral for NHS ‘Talking Therapy’.
Happily, we’re seeing a decline in Z drug prescriptions and efforts to deprescribe people from ‘Benzos’.
Scroll down for more about the new alternative.
Pills, pills, pills.
There is a new alternative to the traditional ‘sleeping pill’ that has recently gained MHRA approval. It’s QUVIVIQ (Daridorexant) from Idorsia.
It’s considered not to have the same habituation (dependency forming) and tolerance issues.
QUVIVIQ has approval for longer-term insomnia and where CBT-I is not available or unsuitable.
Christmas journey with me now to Part 3