2017 HCHB_digital

Sleep Problems and Snoring
Sleep is a vital part of our wellbeing. Despite spending almost one-third of our
lives asleep, scientists still have more questions than answers about why we
sleep. Research has associated lack of sleep (insomnia) with attention deficit
hyperactivity disorder (ADHD), Alzheimer's disease, cardiovascular disease,
obesity, type 2 diabetes, mood disorders and depression. Studies have also
shown that production of immature T cells – a type of white blood cell that are
essential for human immunity – peaks during early nocturnal sleep. Chronic poor
sleep increases your risk of dying from any cause by 15%.
Appropriate sleep durations vary depending on age but range from 14 –17
hours for newborns to between seven and eight hours for older adults. One
night's sleep is actually made up of, on average, five sleep cycles. Within each
sleep cycle, there are five stages of sleep – the first four stages are associated
with non-rapid eye movement (NREM) sleep, and the final stage is when
rapid eye movement (REM) sleep occurs. Each sleep cycle takes about 90
minutes and we briefly wake up between cycles, although most of us don't
remember waking.
Many people experience sleep problems at some point in their life. For the
majority, sleeplessness is only temporary, but for others it may persist for months
or even years. Sleep disturbances may be a sign of an underlying problem, such
as stress, depression, pain, or genitourinary disorders; or due to environmental
disturbances (such as an unsupportive bed or high temperatures); jet lag; shift
work; diet; or having a partner who snores. In many cases, no reason for the sleep
disturbance is found.
Initial assessment
Persistent lack of sleep can take a toll on somebody's health, and you may notice
your customer looks tired or has difficulty stringing sentences together. Take any
complaints of sleeplessness seriously, and congratulate the person on actively
doing something about their lack of sleep, as many people just put up with it
for years.
Referring your customer to a doctor for a sleeping pill is not the right approach.
Although sleeping pills do make people sleep, it is uncertain whether they reverse
any of the conditions associated with lack of sleep and most prescription sleeping
tablets are highly addictive. However, some people may need a doctor's referral
for other reasons, particularly if you suspect there may be an underlying medical
reason for their insomnia.
Try to identify any environmental or other factors (such as stress or diet) that
may be contributing to the lack of sleep and suggest ways to improve these
(see Advice for customers). Relaxation and calming exercises or podcasts that
teach deep breathing, meditation or visualisation techniques should be the next
step (see Sleep and relaxation techniques opposite page). People who travel
a lot and suffer from ongoing jet lag may also like to discuss melatonin with their
TREATMENT OPTIONS
Category Examples Comments
Sedating antihistamines
Melatonin
Anti-snoring treatments
Restless legs/muscle
cramps
Natural / herbal products
/ supplements
[PHARMACIST ONLY MEDICINE]
eg, doxylamine 25mg (Dozile*)
[PRESCRIPTION MEDICINE]
eg, melatonin 2mg (Circadin)
eg, Asonor drops (nasal drops to help dry up secretions),
Aveo TSD Anti-Snoring Aid (device holds the tongue
forward to keep airway open during sleep), Breathe
Right nasal strips (adhesive nasal strips to reduce nasal
congestion), Silence (spray which lubricates nasal passages
and throat), Snoreeze (lubricating throat spray, nasal spray
or oral strips), SnoreMed (mouthpiece holds lower jaw
forward during sleep)
[GENERAL SALE]
eg, magnesium + other ingredients (Crampeze Night
Cramps)
Valerian, lemon balm, hops, lavender oil, passionflower,
skullcap, tart cherry, tyrosine
eg, Good health Deep Sleep, Nutralife Sleep Well,
Remifemin Sleep, Swisse Ultiboost Relax & Sleep
Use only for temporary insomnia due to an identifiable cause (eg, jet lag) and restrict use to
five days. Take 20 minutes before going to bed. Tolerance may develop and side effects include
dry mouth, constipation or blurred vision. Avoid drinking alcohol and driving or operating
machinery within eight hours of taking doxylamine. Has the potential to be abused so refer
suspicious requests to a pharmacist. See OTC Reference section, Precautions.
Melatonin is a hormone produced by the pineal gland which is thought to play a role in
maintaining the body’s circadian rhythm (body clock) as it is stimulated by darkness and
suppressed by light. May cause daytime drowsiness and impaired concentration.
These products will only help snoring, not sleep apnoea. Can be effective for mild snoring.
If snoring persists and/or becomes severe despite using these strategies, refer the snorer to their
doctor.
Magnesium products may provide relief from, and help reduce, muscle cramps and spasms,
tired, aching and restless legs.
Evidence supports the use of valerian and lemon balm to improve quality and quantity of
sleep. Many other ingredients (eg, tart cherry – a natural source of melatonin), lavender,
passionflower) are reported to help sleep; however, evidence is often limited.
Products with an asterisk have a detailed listing in the Sleep Problems section of OTC Products, starting on page 260.
Page 136 HEALTHCARE HANDBOOK 2017-2018 Common Disorders