Drs Paul Doghramji and Leslie Citrome share approaches to communicate with patients and increase awareness of insomnia disorder
Paul Doghramji, MD, FAAFP: Let’s wrap things up by talking about insomnia in general and treatment. So far we’ve talked about the fact that insomnia is so prevalent in the general population—in our practices, in primary care, and in psychiatry. It’s often comorbid. Patients don’t ask about it. There are a lot of treatment options that we have, both medicinally and nonmedicinally. As far as medications, there are a lot of approved medications for insomnia. Leslie, what advice do you have for clinicians as far as improving the awareness of their patients with insomnia and sleep disorders? What to do about them?
Leslie Citrome, MD, MPH: We need to have a conversation with our patients routinely about their sleep, and we need to set aside enough time to discuss that. The last thing we want is someone to say, as they’re opening the doorknob on the way out, “By the way, I’m having trouble sleeping.” Then you’ll have to make another appointment to discuss this further with them if you have a waiting room full of patients. Because you do need to spend that time. It often gets ignored.
I’m going to tell you about a study done in Norway. I have this in front of me. It’s remarkable: 42000 patients participated in this study looking at their medical records. Forty percent of these patients experienced a sleep disturbance. Twenty-two percent reported insomnia as a problem to their caregivers. This was diagnosed in the medical record only 0.08% of the time, which is staggering. This is among mental health care centers where we spend a lot of time on these issues. It doesn’t get the attention it deserves. So No. 1, let’s ask about sleep, and let’s do something about it. Because the spillover effect into all their other conditions and their daytime function is substantial.
Paul Doghramji, MD, FAAFP: In primary care, when patients come to us for their complete physicals, we always emphasize the need for regular exercise, good eating habits, keeping your weight down, and taking your medications properly. How often do we emphasize the need of proper sleep? Getting to bed at the same time every day, waking up at the same time, making sure your total sleep time is adequate, and seeking attention if there’s something wrong with your sleep. How often do we do that? In primary care, with my colleagues I talk to all the time, there certainly is a need to improve in that area.
Hopefully, this discussion has been helpful for all of you to learn about the effects of sleep, the prevalence of sleep, the comorbidities of sleep, and some treatment approaches that we have for our patients. It’s important to make sleep very important in our lives for our patients and to identify insomnia in their treatments. But we should also know that there are many medications available for sleep. The DORAs [dual orexin receptor antagonists] are the most common or novel ones targeting insomnia in a different way than benzodiazepines do. Thank you all for listening. Hopefully this has been helpful for your needs in treating your patients with insomnia. Thank you, Leslie, for being with us.
Leslie Citrome, MD, MPH: Thank you, Paul. It’s always a pleasure working with you.
Paul Doghramji, MD, FAAFP: Thank you very much. Have a good night.
Transcripts edited for clarity