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Now is the time for community pharmacy to help patients with sleep disorders

With increasing rates of sleep disorders, the time to help patients with these ailments is now, says Adrian Zacher 

I will make this direct, so you don’t fall asleep.

With community pharmacists facing existential threats, the time is now for the sector to expand their clinical role into helping people with suspected sleep disorders.

You might be wondering if you’ve enough patients requiring sleep advice?

Or, you might be thinking, how would you commercialise it?

You might even be concerned about the time investment?

But really – why should you care?

Your accessibility, your unique position of trust in the public’s eye, empowers you to lead and transform the nation’s sleep for the better.

Read more: Charity launches free sleep training courses to boost pharmacists’ skills

While we all sleep, some of us don’t sleep very well.

Indeed, insomnia is now widely considered to impact one in three adults in the UK, and we trivialise breathing while sleeping when we laugh and joke about snoring.

There are COVID-19 pandemic-sized issues staring you in the face in community pharmacy right now.

Sleep disorders are a vast unmet need. An untapped market. Yours for the taking.


Why would you do this?


I suspect you feel like a hamster on a wheel. You can’t get off, so the thought of adding anything else is dismissed out of hand.

Read more: Supporting patients to sleep better

But if you found a few hours one evenings or on a Sunday, perhaps, you could break out of the constant treadmill routine, and look to create a new revenue stream that also gives you fulfilment, addresses a huge public health issue and is an unmet patient need.

You would also be offering a service that your local GP needs help with – the truth is they’ve typically had no more sleep education than you.

So, choose to get more informed about sleep, accept free help and free online evidence-based education and communicate with your local GPs.

You would be doing something meaningful that would reduce the risk to your financial survival, should a popular global online retail business launch a box moving business in pharmacy.


How can pharmacists help people with suspected sleep disorders?


Sleep is a dynamic and rapidly developing area for the community pharmacist. One that is happening right now. Not tomorrow.

Read more: Why its vital to talk to customers about sleep

You can learn how to assess, signpost appropriately from your newly found knowledge and use a clinical decision support system to guide you on your way.

Also learn how to question so you can elicit a deeper understanding, guide to appropriate care and offer home sleep apnoea testing when appropriate.

But please don't provide placebos or supply products explicitly not recommended by NICE guidelines. 

Don't worry about finding the time. Simply start at the beginning. Try evening or weekend consultations and develop an interest. The rest will follow.

Still not convinced? When anecdotally, one in three reported consultations are sleep-related – why do we trivialise this? What other patient complaint would be treated like this?


Let’s talk about insomnia


Most know that insomnia and mental health are often inter-related.

But now we need to discuss education. Is your knowledge of insomnia evidence-based?

First line therapy for insomnia is not a first-generation sedating antihistamine. It is cognitive behavioural therapy for insomnia (CBTi) in line with NICE guidelines.

Indeed, in Scotland CBTi is a funded option.

Read more: What should you advise this patient struggling to sleep?

As a pharmacist, do you query the long-term use of ‘Z’ drugs? You should!

And then what if the patient has symptoms of COMISA? ‘Co’ what? You might ask?

Answer: Comorbid insomnia and Obstructive Sleep Apnoea.

Would you recognise the symptoms? What would you do? Suggesting the patient visits their GP immediately is not helping them and is missing a commercial opportunity.

Which leads me neatly on to Obstructive Sleep Apnoea (OSA) and snoring.


OSA and snoring


Snoring may be a symptom of OSA. This is when you are unable to sleep and breathe at the same time.

For the snorer and partner, the social consequences alone merit valid help and not the typical trivialisation.

The undiagnosed and untreated OSA sufferer will have increased morbidity and die sooner than the effectively treated one. It makes economic sense to treat OSA.

Read more: Quality of sleep can address obesity and diabetes, review finds

Ever heard of a sleep-trained dentist? I didn’t think so.

Why does that matter? Because they’re the only healthcare professional who should supply intra-oral anti-snoring devices.

Sleep-trained dentists may prescribe the NICE recommended first-line therapy for primary snoring: a mandibular advancement device.

While we’re discussing snoring – did you know that the GP has nothing, zero, nada, zilch to offer for primary snoring without symptoms of OSA?

But how would you know if snoring is ‘benign’ or a symptom of OSA?

One answer would be to refer everyone to the GP and let them work it out.

No! Besides not making friends, you’re missing a commercial opportunity and positive patient outcome. So don’t trivialise snoring and sell a placebo or gadget.

Read more: To sleep, perchance to dream: ay, there's the rub

Consider the implications of selling a gumshield and unwittingly finding yourself liable for unwanted tooth movement and temporo-mandibular joint dysfunction – unless of course you are double qualified as a dentist and pharmacist!


So, how do you make money from sleep?


There are private fee-paying options and the Community Pharmacy Consultation Service (CPCS), which lists ‘sleep difficulties’ and ‘tiredness’ as suitable for referral to pharmacy.

You can charge self-presenting suspected sleep disorder patients, a small initial fee of £30 to undertake an online evening or weekend consultation.

If you chose to use a clinical decision support system, it would aid your assessment, recognition and signposting.

When appropriate, you could also offer home sleep apnoea testing as a private option.

Read more: Broken Dreams

Signposting is a key role for the pharmacist, and this would be another step on your journey away from moving boxes.

You don’t need much time or money to begin.

Roughly three hours’ CPD and you’re off.


Would I be out of bounds?


There’s an argument that if you're selling placebo products and gadgets with little or no evidence to support their place on the market, you could already be out of bounds.

Indeed, some of these products are explicitly not recommended by NICE guidelines or are out of your professional scope of practice.

This can only be because you don’t know.


Adrian Zacher is CEO of The British Society of Pharmacy Sleep Services

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