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With one in three adults suffering with sleep problems, understanding the strategies and lifestyle changes customers can make to reclaim their rest is essential

There’s a strong link between sleep and mental health, and a lack of sleep is linked to physical problems like high blood pressure and heart disease too. 

Research from YouGov in 2022 indicated that 11 per cent of UK adults say they feel stressed every day, with 41 per cent suggesting that feeling tired and not getting enough sleep were the most common causes of their stress. 

How can pharmacy help with this highly complex issue? Before people reach for OTC sleep aids, it is important to find out what might be going on in their lives that might impact their sleep, suggests Neil Shah, founder and ‘chief destressing officer’ at the Stress Management Society.

“Pharmacists and GPs can provide temporary solutions, but a quick fix from a blister pack or a commercial product doesn’t last. We need to consider what the barriers are to adopting healthy habits to reduce stress and promote better sleep.”

Pharmacists are in an excellent position to be able to ask questions and offer choices, says Shah. “People can choose to carry on as they are and get the same results, take a product or medication or take action.

"What we should be prioritising in primary care is giving people choices. Advise people about the pros and cons of each option and empower them to help themselves.”

Jonathan Burton, RPS Scotland board chair says that it is important to identify whether the issue is short term or long term, and also if there is a specific trigger for the stress and/or sleep problems.

“Some patients may simply require self-care advice, such as good sleep hygiene measures and possibly a recommendation for a short-term sleep aid medicine. But some may require a more in-depth consultation to explore underlying issues such as depression and anxiety,” says Burton.

Shah points out that pharmacists have the knowledge to provide a range of solutions, including medication, as part of an overall treatment modality.

“However, if the strategy is purely based on medications or even herbal remedies, once you stop taking the products, you’re back to square one,” he says. 

“We should be empowering people to see using a product in the short term as just one part of a solution for stress and insomnia ...while encouraging them to do the work that will help them long term.”

“Stress and sleep disorders significantly impact physical and mental health, with insomnia alone affecting over 30 per cent of adults,” comments Alison Cullen, nutritional practitioner at A. Vogel. “Pharmacists can play a crucial role in supporting patients to manage stress and improve sleep quality, using evidence-based lifestyle advice.”

She suggests that open-ended questions are helpful in identifying challenges with sleep or stress, adding: “Share the benefits of natural remedies alongside lifestyle changes, as remedies can produce benefits that encourage adherence to lifestyle improvements. It’s easier to commit to lifestyle changes if you’re not worn out by nights of bad sleep!

"Match product recommendations to individual needs, such as work-related stress or disrupted sleep patterns.

“By combining scientific insights with practical tools and herbal remedies, pharmacists can empower patients to sleep better and live healthier, stress-resilient lives.”

Adrian Zacher, CEO the British Society for Pharmacy Sleep Services (BSPSS), urges caution too. He says: “Pharmacy is at the coalface of healthcare, but while primary care is well educated in sleep disorders, in many cases they are also misinformed, and will reach for a first-generation sedating antihistamine as the first line of treatment in cases where it’s not recommended.”

He suggests that community pharmacy would benefit from having a reliable source of information on insomnia, which is what the BSPSS provides.

“We offer free, independent, evidence-based education online and our professional pharmacy service also offers the chance of revenue that exceeds the margins possible from selling OTC insomnia medications,” he says.

Burton suggests that for short-term insomnia, traditional OTC sleep aid medications such as those containing promethazine and diphenhydramine can help but adds: “It’s important to highlight the short-term nature of these treatments and they do have abuse potential.”

Escalation

Around one in three adults struggle with insomnia and one in four men have difficulty breathing when asleep. It’s important to recognise when to escalate customers with insomnia, looking for OTC products for sleep problems.

Zacher explains: “Menopausal women, for example, might think they have insomnia, but their symptoms can mask obstructive sleep apnoea (OSA), which most people think only affects obese men in their fifties.

"Most women don’t tick the boxes and so it doesn’t get picked up. COMISA (comorbid insomnia and sleep apnoea) is also far more prevalent than people realise.”

He suggests that anyone diagnosed with type 2 diabetes should be screened for OSA. “You’re five times more likely to have a stroke if you have untreated OSA. If you’re obese, you may find that losing weight can decrease severity and incidence of apnoeic episodes.”

Burton suggests that if a customer is repeatedly buying insomnia remedies, they should approach the subject sensitively. “Offer a private consultation if appropriate. Find out what the issues are and try to help the patient find solutions.

"This may involve advising on sleep hygiene measures and asking a few more questions to figure out if other underlying medical or mental health issues may be involved.”

Lifestyle changes

Zacher’s advice involves advising people to change their mindset and habits, with the first tip being: “If you’re not tired, don’t go to bed.”

Other suggestions include:

• Keeping the bedroom just for sleep and intimacy
• No caffeine after noon
• Frontloading liquid intake - drinking two-thirds of your daily fluids before noon and avoiding fluids after 8pm.

If those tips still aren’t working, it sounds counterintuitive, but sleep restriction can be a powerful method of resetting sleep debt, advises Zacher. “If you need eight hours of sleep, permit yourself six. This increases the drive to sleep. It can be brutal, but it works. If you need to get up at 6am, don’t go to bed until 1am.

"You’re aiming for sleep efficiency; getting the time you spend in bed and time spent asleep to be as close as possible. You should fall asleep as soon as you go to bed because you’re tired.”