How to optimise sleep services in your pharmacy
Three pharmacists tell Saša Janković how they recognise and support customers with sleep issues
Sleep plays a vital role in protecting mental and physical health, yet studies consistently show that many people are experiencing problems with getting enough shut eye.
Recent data from the charity Mental Health UK shows that almost one in five people in the UK aren’t getting enough sleep; 66% of adolescents cite poor sleep as negatively impacting their mental health; and women, black, Asian and other minority ethnic adults are disproportionately likely to experience poor sleep.
But community pharmacy teams are in an ideal position to support patients to get a good night’s rest – and channelling their specialist knowledge into a private service can generate much-needed revenue in the process.
How to spot customers with sleep problems
Community pharmacy teams are often approached by customers experiencing problems with sleep, although some signs are more obvious than others.
Shilpa Patel is lead prescribing pharmacist and partner at WellBN in Brighton & Hove. With 17 years’ experience working in community pharmacy, she says spotting customers who are struggling to sleep involves more than taking their queries at face value.
While many customers will present in the pharmacy looking for over-the-counter (OTC) or prescription medication to help with insomnia, she points out that sleep issues can also be detected when teams are presented with concerns about sleep disorders such as sleep apnoea, restless leg syndrome or narcolepsy. “These individuals may require assistance in understanding their condition, exploring treatment options, or discussing potential medication interactions,” she says.
There are a host of other symptoms that may point to problems with sleep.
“Customers experiencing chronic fatigue, daytime drowsiness, or difficulties concentrating may seek advice from pharmacists on potential causes and remedies”, adds Ms Patel, “and sleep problems can indirectly manifest in a pharmacy setting through customers seeking recommendations for stress or anxiety relief.”
Using CPCS for problem sleep referrals
Gareth Evans is president of the British Society of Pharmacy Sleep Services (BSPSS), and a pharmacist at Wansford Pharmacy near Peterborough. He says for the majority of community pharmacies that are not yet offering specialised sleep services, the community pharmacy consultation service (CPCS) is a great gateway for addressing sleep issues with customers.
“Everyone is aware Z drugs, benzos and hypnotics are overprescribed,” he acknowledges. “But with so much inherent pressure on primary care, prescribers don’t always have the time to get to the nitty gritty of what’s causing the patient’s sleep problems in the first place.”
He stresses that this is precisely where pharmacy teams “can make a real difference, by starting the conversation with patients”. “Since ‘sleep difficulties’ is a broad term under CPCS, anyone reporting sleep problems can be referred straight through to pharmacy for advice and screening,” he notes.
Read more: How should you tackle this insomnia case?
Mr Evans advocates engaging with GPs to boost CPCS referrals for sleep issues. “We have the availability and accessibility to take these patients on if they send them to us via the CPCS route – and then of course we get paid to have that conversation,” he says.
As a pioneer of sleep services in community pharmacy, Mr Evans uses the templated pathway designed by the BSPSS in his pharmacy to screen patients reporting sleep problems, which firstly checks for a physical cause – the most common of which is sleep apnoea.
“Sleep apnoea is implicated in pretty much all sleep disorders in most people,” he says. “So the most important question to ask is, ‘Do you snore?’ The pathway includes taking a medical history and a mental health assessment, plus an extra insomnia severity index questionnaire if needed.”
Adding on paid-for sleep services
Mr Evans charges £30 for the sleep apnoea screening, insomnia severity, medical history and mental health assessment, but stresses: “If someone has the potential for proper sleep apnoea, we are only screening; we can’t diagnose – and that has to be done in secondary care, not by a GP.”
But he points out that the screening service can still be “of benefit” to the patient because if a potential problem is detected, the patients can buy a home sleep apnoea test through the service for around £150-£200. “That will then provide the data which their GP needs in order to make a referral to a sleep clinic,” he says.
On top of CPCS referrals and snoring screening, Mr Evans – like Ms Patel – says observant pharmacists and staff can identify customers who might be struggling with sleep issues in other ways.
“The pandemic has definitely made sleep problems worse for a lot of people,” he says, “but what really brought it to my attention as a clinician was my weight management specialism and linking this with sleep apnoea, which really gets the conversation rolling with customers.”
Other services that monitor blood pressure can also alert pharmacists to patients who may be struggling with sleep. Mr Evans recalls one patient who was referred for a blood pressure check and reported feeling tired all the time.
“So we did a snoring screening and as he was overweight we helped him with weight management as well,” he says.
Promoting sleep hygiene
Luxury pharmacy John Bell & Croyden offers a wide range of services, and superintendent pharmacist Reshma Malde says she often sees customers who mention sleep problems. This gives her and her staff plenty of opportunities to offer advice that can help, starting with information about sleep hygiene.
“Often, small changes to health and lifestyle can improve the quality of one’s sleep,” she says. “So we start with understanding what the customer’s sleep routine is.”
The team ask patients simple questions, such as whether they go to bed straight after watching television or being on the phone, as this could mean that “their mind is still active” when they are trying to drift off. Patients are also quizzed on whether they have a “wind-down process”, about their diet and about their sleeping conditions.
Where a person sleeps is just as important as when, says Ms Malde. “We get people to think about the temperature of their bedroom”, she explains. “Too hot or too cold doesn’t settle the body down. Is there noise that maybe disturbs sleep? Are they staying in bed hoping to fall back to sleep rather than getting out of bed and doing something else – for example, reading – and then coming back to bed?”
Pharmacists are also ideally placed to point out the link to customers between medication and sleep. “We ask our customers if they are on any medication that could be disturbing their sleep”, says Ms Malde, “since those such as diuretics, when taken late on the day, can keep you up as you need go visit the toilet frequently.”
Three tips for boosting sleep service profits
Look beyond customers seeking OTC or prescription medication for insomnia to find others who may be struggling with sleep issues
Ask GPs to refer patients with sleep difficulties to the CPCS for initial help and advice
Consider setting up a private sleep apnoea screening service
Although a relatively new area when it comes to services in pharmacy, helping customers get to the bottom of their sleep problems is a vital – and growing – role for the entire pharmacy team.