Case scenario

Felix, 75 years, tells you he sleeps poorly these days. For the last 6 months he has been waking 2–3 times during the night, and it takes him a long time to get back to sleep. He worries about his wife, who is getting frail and may need to go into care. They don’t go out much and rely on delivered evening meals.

He asks if he can take valerian with his other medicines, as it’s a natural product. His medicines are irbesartan, atorvastatin, and ibuprofen when needed for osteoarthritis. How do you respond?

Learning objectives

After successful completion of this CPD activity, pharmacists should be able to:

  • Recognise when referral is appropriate for patients with sleep disturbances
  • Discuss pharmacological management options for insomnia, including non-prescription medicines
  • Explain the pharmacist’s role in the management of insomnia.

Competency standards (2016) addressed: 1.1, 1.3, 1.5, 2.3, 3.2, 3.5

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Introduction

Insomnia is an inability to fall asleep or remain asleep, despite adequate opportunity, that can lead to daytime impairment.1,2 It has historically been referred to as a primary condition or secondary to another disorder (e.g. depression or pain), and can be acute (short term) or chronic.3 Insomnia is one of the most common complaints presenting to primary care,1 and community pharmacists are in the right place to offer advice on initial management.

The Therapeutic Guidelines state that 30% of the

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