We explore how pharmacy teams can help customers to de-stress and sleep better

According to Mental Health UK’s Burnout report, one in five working adults have needed to take time off work during the previous year due to poor mental health caused by increased pressure or stress. Most people experience stress from time to time, and some stress in the workplace is expected. However, one in four adults (24 per cent) surveyed for the report said they feel unable to manage the stress and pressure in their lives.

Burnout is recognised by the World Health Organization (WHO) as an occupational hazard that can affect productivity and mental health. However, it isn’t just a work-related issue as stress from other causes, such as financial worries, social isolation or poor physical health, can make burnout worse. In the Burnout report, six in 10 people said that poor sleep contributes to their burnout, and a significant proportion of respondents said that problems with personal relationships and caring responsibilities contribute towards their stress levels as well.

In January this year, a joint workforce and wellbeing survey by the Royal Pharmaceutical Society (RPS) and Pharmacy Support revealed that 86 per cent of pharmacists are at high risk of burnout. This may be triggered by inadequate staffing, lack of work-life balance, absence of colleague or senior support, and long working hours.

“While some stress is inevitable, it’s essential to recognise that a stressful workplace doesn’t have to be the norm,” says Melissa Cochrane, wellbeing development manager at Pharmacist Support. “Our Embracing a Workplace Wellbeing Culture course offers practical strategies tailored to the pharmacy setting, empowering teams to foster a supportive work environment. Through our free-to-register Wellbeing Learning platform, we aim to equip pharmacy professionals with the tools they need to address stress and enhance their overall wellbeing.”

Insomnia impact

According to Mental Health UK, almost one in five people in the UK don’t get enough sleep on a regular basis. Poor sleep quantity is usually considered to be sleeping for fewer than seven hours a night. Sleep disturbance means struggling to fall asleep within 30 minutes, waking up in the middle of the night or early morning, and a self-rating of poor-quality sleep. Occasional sleep disturbances are normal, but persistent problems may be a sign of an underlying health issue, such as sleep apnoea (causing snoring), restless leg syndrome or mental health conditions such as anxiety or depression.

Insomnia can affect physical and mental health and has been linked with chronic diseases and accidents. A new survey commissioned by Kalms Herbal Remedies, conducted with 3,700 adults, has found that half of people experiencing sleeping problems report feeling groggy, tired and irritable the following day. This lack of rest also hampers their ability to concentrate, leading to reduced productivity and increased errors.

“Helping patients achieve a good night’s sleep is key to their overall health and wellbeing,” says Denise Iordache, sleep therapist and founder of JoySpace Therapy, which includes a four-week Better Sleep. Perform Better programme. “As trusted healthcare providers, community pharmacists can guide towards implementing simple yet effective sleep hygiene practices. Encourage patients to consider their daytime habits as well, as these can greatly impact sleep quality. Regular exercise during the day can promote better sleep at night, but advise against intense exercise too close to bedtime as it may have the opposite effect.”

Patient support

The Dreaming of Change: A Manifesto for Sleep report by The Sleep Charity, published in April, found that nearly 70 per cent of people with undiagnosed sleep problems never seek support and have instead lived with their problem for an average of more than six years. In addition, many people try to self-manage their sleep issues, and more than a third are unaware of best-practice sleep advice. One in 10 respondents said they have tried drinking alcohol to help them get a good night’s sleep, while one in 20 admitted to taking someone else’s sleep medication.

The Sleep Charity is calling on the Government to introduce a “desperately needed” National Sleep Strategy, and to update the Making Every Contact Count (MECC) framework and training to include sleep hygiene advice. Currently, the information offered through MECC focuses on healthy eating, exercise, reducing alcohol and stopping smoking.

“Community pharmacy teams can play a vital role in helping customers struggling with sleep disturbances and start those all-important conversations,” says Lisa Artis, deputy chief executive at The Sleep Charity. “Pharmacy professionals can also look at identifying at-risk individuals by using screening tools, such as sleep diaries or questionnaires, and guiding them towards interventions suited to their needs. The Sleep Charity provides lots of sleep training for health professionals at sleepwellacademy.org.uk.”

Samantha Sutton, pharmacist at John Bell & Croyden, says that community pharmacists could target specific customer groups with tailored questions to assess their sleeping habits. High-risk groups include older adults, shift workers, people with chronic health conditions or chronic pain, those with mental health issues, parents of young children, individuals with corporate lifestyles, and those affected by various lifestyle factors contributing to sleep disturbances.

“My team and I play a crucial role in identifying customers with insomnia through various strategies aimed to maximise every patient interaction,” says Sutton. “Using active listening techniques to attentively listen to customers’ concerns and identify key symptoms, such as fatigue, irritability and difficulty concentrating, helps to uncover patients with potential sleep disturbances. Conducting in-person medication reviews with patients and using techniques such as open-ended questions also helps to gather valuable insights into a patient’s overall wellbeing, both physically and mentally.”

Sleep hygiene

Sleep hygiene, the first step in insomnia management, involves discussing health and lifestyle changes that are tailored to the individual patient.

This may involve weight management, smoking cessation and reducing alcohol intake. Pharmacists could also point out the link between sleep and medicines such as diuretics, which increase toilet frequency. To establish other causes, community pharmacy teams could ask about a customer’s bedroom environment, such as the temperature, how light it is and whether it’s noisy. If customers can’t sleep, do they stay in bed or go and do something else for a while, such as read? Do they go straight to sleep after watching television or using their phone, or do they have a wind-down routine in the evenings? 

“Creating a conducive sleep environment, with elements such as darkness, quietness, cool temperatures and comfortable mattresses, is essential for optimising sleep quality,” says Sutton.

Managing underlying stress levels is also important to establish better sleep patterns. “Whilst occasional stress is common, persistent stress can significant impact daily life,” says Alwyn Fortune, community pharmacist and RPS policy and engagement lead for Wales.

“Community pharmacy teams are well equipped to recognise the signs, including physical symptoms, such as headaches and muscle tension, along with mental and behavioural changes such as difficulty concentrating, feeling overwhelmed, increased irritability and drinking or smoking more.”

OTC sleep remedies

If lifestyle changes aren’t helping to ease sleep problems, pharmacy customers are likely to seek advice on suitable over-the-counter products. According to March 2024 Statista market insights on Sleep Aids – United Kingdom, the UK sleep aids market is being driven by a high-stress work culture. Many people are seeking out natural sleep aids, such as herbal remedies, aromatherapy products and sleep-inducing teas, as these provide a temporary solution for occasional sleep disturbances without the risk of long-term dependency. CBD supplements are also being increasingly used to cope with anxiety, stress and sleep problems.

“For customers looking for more support, there are OTC options available,” says Elizabeth Hughes-Gapper, Kalms senior product manager at Lanes Health. “Whilst effective, antihistamines’ sedative properties often last well into the next day, leading to a ‘hangover’ effect. When used long-term, they can also cause forgetfulness and headaches. Because of these issues, pharmacists advise against their regular use. We’re witnessing increasing consumer preference for natural and herbal sleeping aids due to concerns about side effects from sedatives.”

Sutton recommends referring customers to a nutritionist for herbal and supplement-based sleep support, such as valerian root extract or magnesium. “This is especially relevant for individuals who have contraindications or potential interactions with prescription sleep medications,” she says. “Moreover, those seeking a more holistic approach to their healthcare may also find value in incorporating OTC products and herbal remedies into their sleep management regimen.”

Pharmacies can also advise on management approaches to reduce environmental triggers – it is much easier to fall asleep when a bedroom is cool, dark and quiet, for example. “Pharmacies can stock and recommend low-cost aids such as earplugs and sleep masks, providing practical solutions that enhance sleep quality without resorting to pharmaceuticals,” says Artis.

Making referrals

Sutton and her pharmacy team refer customers to their GP if sleep problems persist for an extended period, typically several weeks or months, without showing improvement despite self-care measures or OTC remedies, or if their insomnia is affecting their day-to-day lives. “Referral is also necessary for people with ongoing mental health conditions, as sleep problems may be indicative of underlying issues requiring specialist intervention,” she says.

“Patients experiencing medication side effects or interactions related to sleep aids should consult their GP for assessment and management. Finally, if there are any concerns about the abuse or misuse of sleep medications, referral to a GP is essential.”