The Guardian reported last week (July 13) that professional footballer Dele Alli had openly acknowledged his struggle with sleeping tablet addiction. His admission highlighted an issue that is not unique to him.

As a pharmacist, I have personally witnessed the detrimental effects of sleep medication addiction on individuals and their loved ones. It is my firm belief that community and general practice pharmacists are in a prime position to address this growing concern and that urgent attention and intervention are necessary.

 

Potential addiction risks

 

While occasional sleep disturbances are normal, a persistent sleep problem may be a sign of an underlying condition. If sleep problems are accompanied by other health issues, it is crucial to explore the condition further. Certain medical conditions like sleep apnoea, restless leg syndrome, or even mental health conditions such as anxiety can result in sleep disturbances. Feeling excessively fatigued, having trouble concentrating, or encountering mood swings can be indicators of a sleep problem that goes beyond a mere sleep disorder.

Sleep medication addiction, or hypnotic or sedative-hypnotic drug addiction, occurs when individuals excessively and persistently use prescribed medications for sleep disorders. Medications, originally intended to treat insomnia or other sleep-related problems can become relied upon and potentially depended on.

They can alter brain chemistry and affect the brain's natural sleep-wake cycle and neurotransmitter systems. The easy accessibility of sleep medications contributes to this addiction, as individuals obtain them through prescriptions or over-the-counter (OTC) purchases without fully comprehending the associated risks.

Read more: How should you tackle this insomnia case?

There is often a misconception that these medications are harmless and non-addictive. However, from many years of experience in counselling patients, dispensing sleep medications and witnessing their increasing supply, pharmacists understand prolonged use can result in tolerance, dependence and addiction, which can have serious consequences, including withdrawal symptoms, cognitive impairment, and a decline in overall quality of life.

This is a favourable moment for collaboration between community pharmacists and other pharmacists in primary care to increase sleep medication addiction awareness. Community pharmacists, being the frontline healthcare professionals (HCPs) accessible to the public, play a crucial role in identifying patients at risk of sleep medication abuse. They are well-placed to promote awareness and provide valuable information about the harmful consequences of misuse.

By establishing a strong rapport with patients, they can offer guidance on non-pharmacological interventions, such as sleep hygiene practices, which could help individuals achieve restful sleep without relying on medication. Meanwhile, pharmacists working closely with GPs can identify patients with complex sleep-related issues through comprehensive assessments.

Read more: Crisis, what crisis? MPs must help tackle sleep disorder problems now

Other primary care pharmacists can provide their expertise in developing tailored treatment plans that prioritise patient safety and minimise the risk of medication abuse. This collaborative approach ensures that individuals receive appropriate care and support in managing their sleep-related concerns. By pooling their knowledge and resources, community pharmacists and other primary care pharmacists can establish effective channels of communication and referral systems.

This collaboration enables a seamless transition for patients seeking specialist advice. It also ensures they are supported throughout their healthcare journey. This collaboration also allows for the implementation of educational programmes and awareness campaigns targeting patients and HCPs. These initiatives can help raise awareness about the risks and consequences of sleep medication abuse, ultimately fostering a culture of informed decision-making and responsible medication usage.

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

Pharmacists are valuable allies in spotting signs of sleeping tablet addiction. Their keen observation skills come into play in identifying unusual behaviour and changes in appearance or mood in patients abusing sleep medication. Through their interactions with patients, pharmacists can observe physical and behavioural cues that may indicate misuse.

They are trained to spot changes in appearance, such as bloodshot eyes, slurred speech, or unsteady movements, which are classic signs of sedative abuse. Pharmacists also pay close attention to patients' demeanour and mood alterations.

Frequent irritability, excessive anxiety, or periods of unresponsiveness may suggest the patient is struggling with sleep medication misuse. By establishing rapport and engaging in open conversations, pharmacists can gauge patients' understanding, adherence, and potential misuse of their prescribed sleep medication as well.

Patient medication record (PMR) systems are becoming increasingly advanced and efficient. These systems offer many benefits for both pharmacists and patients, one of which is the ability to generate reports and identify individuals who frequently take sleep medications or repeatedly order them.

Through PMRs, pharmacists can monitor and track medication orders over time. By analysing the data collected in these systems, they can identify patterns and trends in medication use. This allows them to pinpoint individuals who frequently order sleep medications or exhibit a recurring need for these drugs.

PMRs also provide a centralised database that enables pharmacists to access a patient's complete medication history. This helps identify any potential drug interactions or contraindications, ensuring patient safety. By sharing insights with other HCPs they can initiate early interventions for patients at risk.

 

Responding to sleeping tablet addiction

 

Once a potential addiction is identified, pharmacists should approach the situation with empathy and sensitivity to build a relationship of trust with the patient. Showing compassion towards patients is an integral part of this. They should acknowledge the emotions and struggles that patients may encounter while managing their health conditions. By expressing understanding and support, they can create a safe and comforting environment that encourages patients to open up and share their concerns.

By taking the time to understand patients’ concerns, needs, and expectations, pharmacists can effectively address any medication-related issues or questions. Patients feel valued when they know their voices are heard, which only strengthens the pharmacist-patient relationship. By fostering this trusting relationship, pharmacists can encourage patients to share their struggles and seek the necessary help.

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

In terms of dealing with a sleeping tablet addiction, they should prioritise patient education and counselling. Each patient suffering from sleeping tablet addiction is unique, and a one-size-fits-all approach may not be effective. Pharmacists should provide holistic treatment plans based on individual needs and circumstances.

This may involve gradually tapering off the medication, exploring non-pharmacological approaches, or suggesting alternative pharmaceutical options under medical supervision. They possess the knowledge and skills necessary to guide patients through the process of gradually reducing their sleep medication dosage.

They can assess the patient's medical history, sleep patterns, and medication details to create a personalised tapering plan. This plan will include gradually reducing the dosage over a specified period, minimising withdrawal symptoms, and ensuring a safe transition. As patients begin to taper off their sleep medications, pharmacists can monitor their progress closely. Regular check-ins allow them to evaluate the patient's response to the tapering plan, identify any challenges, and provide necessary support and guidance.

This ongoing monitoring helps to ensure patients remain on track and have a fulfilling tapering experience. Alongside tapering, pharmacists can suggest alternative strategies to improve sleep quality. These strategies may include adopting healthy sleep habits, such as practising good sleep hygiene, creating a relaxing bedtime routine, and managing stress.

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

In conclusion, sleeping tablet addiction is a serious issue that requires a collaborative and patient-centred approach from community and other primary care pharmacists. It is crucial for them to be well-informed about the signs of addiction and to create a supportive environment for patients. By collaborating with other HCPs, providing education and counselling, and offering ongoing monitoring and support, they can play a significant role in helping patients overcome their addiction and establish healthier sleep patterns.

Together, we can make a positive impact on the lives of those struggling with sleeping tablet addiction.

 

Shilpa Patel is the lead prescribing pharmacist and a GP partner at WellBN in East Sussex