Karen Jensen and Fred Remillard from the College of Pharmacy and Nutrition

4:04 am: Sleep not found

Chances are you have had a restless night or two in your life when despite all the tossing, turning and sheep-counting, sleep just does not come easy.

Chronic sleep disorders such as insomnia can wreak havoc on one's physical and mental health, leading many sufferers to take sleeping pills to help them get some shut eye.

The College of Pharmacy and Nutrition is piloting a new program that looks at non-med­ication therapy to help those suffering from insomnia who may or may not be taking drugs to assist with their sleep.

PharmaZzz is led by Fred Remillard and Karen Jensen. Remillard is a pharmacy professor and holds a clinical practice with the Saskatoon Health Region specializing in psychiatric and neurologic disorders. Jensen is a pharmacist and the manager of medSask, a public medication informa­tion service located within the college. She said that sleepless­ness is an issue that comes up often with patients, especially those taking prescription sleep aides (such as hypnotics and sedatives).

"We get a lot of calls from people who have been on their sleeping pills for years and years, and they want to stop but they can't because there's no option," she said. "They really feel that if they stop on their own, they're not going to be able to sleep, or they've already tried it and it hasn't worked for them."

Additionally, hypnotics are meant to be a temporary solution, said Remillard, and many people have trouble getting a restful night of sleep without them.

"The person becomes tolerant within a few months, and it affects your sleep patterns if you're on them for too long," he said.

PharmaZzz consists of six cognitive behavioural therapy (CBT) sessions for insomnia administered by community pharmacists. Long used for mental health issues such as depression and bi-polar disorder, CBT is a type of therapy that assists in changing patients' way of thinking at the neural level. In this case, said Remillard, it is more focused at the elements of sleep disturbances.

He explained that many people distort or catastrophize their own thoughts if they have trouble falling asleep. Their minds typically wander from "I can't sleep" to "I'm going to lose my job if I don't fall asleep," a line of thinking that does not help the situation and only causes more anxiety and restlessness. CBT gets to the root of the sleep disturbances by changing the patient's thought pattern and behavior, albeit with some personal commitment.

"Any kind of CBT requires work from the patient them­selves," said Remillard. "It's not just therapist-driven." He lists the program's sleep logs as an example.

"You have to figure out how long you were in bed, how long you slept, whether you woke up, how long did it take you to fall back asleep again without looking at a clock. So there's a fair amount of homework to collect the sleep logs on a daily basis."

Additionally, sleep is initially restricted for patients. Jensen said that while it sounds coun­terintuitive, it works to "limit the amount of time in bed that they actually sleep, and then gradually decreasing that so that when they're in bed, they're asleep."

Maintaining good sleep hygiene is also promoted, such as avoiding coffee in the afternoon or not having a television in the bedroom. While these are good strategies to follow, "it's not enough on its own," said Jensen. "You have to change those patterns and thoughts that have built up over the years."

So far, 16 Saskatchewan pharmacists have received training for PharmaZzz and the feedback has been positive. Remillard would like to see it incorporated as a professional cognitive service, because sleep is "a universal interest." And as the list of health conditions linked to sleeplessness continues to grow, it is an option worth exploring.

"What's unique about CBT is that the emphasis is on changing the behaviour," said Jensen. "All of the literature ranks CBT right up there for treating insomnia. There's been quite a bit of work done on it and it works equally well as the sleeping tablets, and it's something that has long-term effects, which medication doesn't."

Quick tips for getting a good night's sleep

Work on your sleep efficiency. 
"If you're in bed but can't fall asleep, get out of bed," said Remillard. "Don't force it, because you'll get frustrated, which is not conducive to falling asleep."

Give your technology some space. 
"The bed in your bedroom is meant to be strictly for sleep, not as a stimulus for watching television or playing on your phone," said Remillard.

Avoid stimulants such as nicotine and caffeine. 
Or, "if you have to use them, use them earlier in the day," said Jensen.

Steer clear from excessive amounts of alcohol. 
It may make you drowsy initially, but it decreases the quality of your sleep, explained Remillard. "You'll get broken sleep—your deep sleeps are not there, and you actually get quite a disrup­tive sleep and are more tired the next day."

It happens to everyone. 
"People shouldn't stress about an occasional night of bad sleep," said Jensen. "If they do find their insomnia is persisting, though, they should seek help."

Numbers are not everything. 
Not everyone needs the same amount of sleep every night, said Jensen. "Sometimes all it takes is assuring someone they don't need a full eight hours of sleep if you feel good the next day."
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