There is no clear number to quantify the prevalence of insomnia. Worldwide, studies have shown anywhere from 10-60% incidence. Insomnia is classified by a few different organizations, including the international classifications for disease (ICD-10), International classification of sleep disorders (ICSD), and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). All three of these organizations require difficulty either A) falling asleep, B) staying asleep or C) poor sleep quality. The biggest difference in the organizations’ definition of insomnia is the frequency of symptoms and daytime symptoms that result from lack of sleep.
There are many things that can lead to insomnia. It is important to gather a full patient history to help determine the causes. As we age, this tends to lead to a higher incidence. Other reasons can include urinary or bowel disturbances, poor sleep hygiene, medications, pain, respiratory issues, and mental health issues. When it comes to medications, different steroids such as prednisone or dexamethasone, antidepressants such as fluoxetine (Prozac) and bupropion (Wellbutrin), and diuretics such as furosemide can all contribute to insomnia. Unfortunately, we use the medications listed for a variety of symptoms in patients who have elected to obtain hospice care. Minimizing use and changing the times that we give these medications to no later than 2pm can usually decrease insomnia as a side effect. If there are other reasons for the insomnia, such as depression, anxiety, or pain, it is important to treat the condition causing the insomnia rather than jumping straight to a sleep aid.
Some non-medication practices that can help with sleep include:
- Keep a schedule.
- Don’t go to sleep unless you are tired.
- If it takes more than 20 minutes to fall asleep, get out of bed and do an activity for a little bit. Then try again.
- Limit light from the outside, hallways, phones, and other electronic devices.
- Only eat light snacks before bed.
- Avoid alcohol and caffeine before bed.
Medications are also an option for patients who do not have success with the non-medication practices. Unfortunately, the medications that can have sedating effects to cause sleep are also usually a high risk for causing falls. Because of this, the non-medication therapies for helping to manage sleep are preferred as first line.
Call Hospice of Southern Illinois to learn more about end-of-life care and hospice services, 800-233-1708. Request a chat,
By: Timothy Cruz, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care, Hospice of Southern Illinois
October is American Pharmacists Month and we are proud to present to you an educational blog series throughout the month by, Timothy Cruz, PharmD, PGY-2 Pharmacy Resident in Pain and Palliative Care. Our series will help expand your understanding of the use of medications at the end-of-life.