Episode 1 The Med Thread Show Transcript Insomnia: You’re Getting Sleepy Introduction CB: Hello and welcome! This is Cathy MC: and Mike CB: and we are super excited to be launching our first episode of The Med Thread, a medication information station from the School of Pharmacy at Memorial! Each month we will bring you an exciting topic related to medications, disease conditions, pharmacy practice and more! MC: Today we talk sleeping pills through the ages but Before we start, I believe we should do some introductions! CB: I am a clinical pharmacist working at the Medication Therapy Services Clinic here at Memorial. That’s a mouthful but we call it the MTS Clinic for short. I see patients for a variety of different reasons through the clinic and work with their healthcare providers to make sure they’re on the best medications for them! I also coach a smoking cessation program and I get to do a lot of deprescribing as well – more on that in other episodes! MC: And I am a pharmacist originally from Ontario, moved here to Newfoundland about 10 months ago and now work at the School as the Drug Information Pharmacist. People often ask me what that is, so essentially, I answer any questions about medications, treatments and curiosities from health care professionals all over the province. As I mentioned, we are starting our podcast with some of the earliest drugs discovered and still among the most widely used drugs today – sleeping aids. We’ll take you through a few sleep stats, why sleep is important, what therapies we have and what the evidence says about them. We promise this episode will NOT put to you to sleep, but we are going back in time first. CB: Going way back, ancient Greeks and Egyptians developed sleeping potions using the opium poppy, they distilled morphine and heroin from it for their drowsy properties. Interestingly, the Greek god of sleep, Hypnos, holds a bundle of poppies which he sprinkles over people to sleep. Does anyone remember the scene from the Wizard of Oz of Dorothy in the poppy field? Maybe this will jog your memory: Poppies weren’t the only sleep-aid used through the years – various things were used like the bark of the mandrake root and seeds of the henbane tree – even the juice of lettuce! Apothecaries of the Middle Ages in Europe stocked “spongia somnifera” which sounds like a spell from Harry Potter but was actually a sponge soaked in wine and herbs. Countless “drowsy syrups” were concocted over the years, leading us to where we are today! Let’s get this episode rolling with why sleep is so important… Page 1 of 13 Episode 1 The Med Thread Show Transcript Insomnia: You’re Getting Sleepy Introduction to topic – why we chose sleeping therapies, neat history fact, prevalence MC: According to Stats Canada, more than half of adults in Canada say their shuteye is fitful at times. They did a study of Canadians aged 18-64 over a 6 year time period and found that 43% of men and 55% of women reported trouble going to sleep or staying asleep. That is half of the country! (Chaput, 2017) What makes a person more likely to have trouble sleeping? CB: A few things, including, being female, older age and having a poor impression of your own physical and mental health. Actually, a recent study showed that our trouble sleeping as a nation is driven largely by the midlife women demographic, likely due to hormonal changes, increased stress and being a part of the sandwich generation – taking care of children and aging parents at the same time. MC: Sometimes it is normal to not sleep well – maybe you’re sick, you’re grieving, you’re worried about work or school or children, maybe you had an argument or you’re up late trying to cram for the next exam, maybe you just had kids or you have a big job interview tomorrow. That is normal. And how many people actually seek help for sleep? CB: One study showed, only 13% of those called by a telephone survey said they saw a doctor for their sleep troubles. 10% had used prescribed sedatives in the last year. 9% had used natural products, 6% used OTC products and 5% used alcohol. (Morin, 2011) Why sleep is a problem – why it is important and why we turn to medication CB: Your body needs sleep to repair and restore. Sleep helps to improve mood and lowers stress, improves athletic performance and coordination, and increases your ability to pay attention and remember new information. It also helps you regulate your appetite hormones and maintain a healthy weight. One study showed that sleep actually gives your brain a bath! They found that during sleep your body flows Cerebrospinal fluid over the brain and opens interstitial spaces to help clear the neurons of waste products, and lack of sleep may actually lead to degenerative disorders like Alzheimer’s disease! Pretty incredible right? (Xie, 2013) MC: I also read that when you’re sleep deprived there is a 40% decline in learning compared to those that are well rested, and when people get less sleep they tend to see the “glass as half empty” instead of full! (Walker, 2006) (Vargas, 2017) We know that we need sleep to function properly, but how much sleep? CB: The Sleep Foundation says adults 7-9 hours of sleep a night. Kids need more and older adults may require a little less, but the old 8 hours a night tends to fit for most people. (Hirshkowitz, 2015, https://sleepfoundation.org/sleep-duration-recommendations) Page 2 of 13 Episode 1 The Med Thread Show Transcript Insomnia: You’re Getting Sleepy MC: Now, I certainly don’t get the 7-9 hours, but it begs the question, are we sleeping less than we used to? And maybe we don’t need that much sleep now? CB: Well, our sleeping patterns are getting worse – Stats Canada found that Canadians are getting about an hour less sleep per night than we used to with an average of 7.12 hours more recently compared to a blissful 8.2 hours in 2005. (Chaput, 2017) MC: That’s an extra hour of work I can do! I read an article in the news where Dr. Luc Beaudoin, a professor at Simon Fraser University says “We’ve got time compression” – people have an enormous amount of activities that they need to do or that they feel they need to do. And it’s true but I do try to make up for it! (Lee, 2017) CB: Yes, and we’re turning to the old ‘cup of joe’. It is not OK to just work on a few hours of sleep and big cups of coffee. According to the AAA foundation for traffic safety – drivers who get one or two hours less than the recommended 7 hours of sleep nearly double their risk for a car crash! And those that miss 2-3 hours of sleep QUADRUPLE the risk. And even though the overwhelming majority surveyed say they believed driving while drowsy is completely unacceptable behavior, 1/3 admitted to doing so at least once in the past month. (Tefft, 2016) MC: So how do I know if I have insomnia? (Therapeutics briefly adapted from TOP, CEP Tool, DSM-V, drug monographs) CB: To be considered to have insomnia disorder you have to have trouble sleeping despite an adequate opportunity for sleep and you have to have daytime impairment. You can have trouble at the beginning, middle or end of the night and in order to be classified as a disorder you have to problems at least 3 nights per week. MC: There is a difference between not sleeping for a few nights here and there and not sleeping for months. CB: There sure is. Acute insomnia lasts less than a month and chronic lasts more than 3 months. Acute is just when you’re adapting to a new situation or going through a life event like an illness or stressful time, or even when you go through jet lag or adjust to shift work. This usually goes away when the event goes away but sometimes it can morph into a chronic problem. Chronic insomnia can either have no real reason or rhyme to why it happens but it can also be secondary to another medical issue like pain or dementia, hot flashes, restless legs syndrome, sleep apnea, a psychiatric illness and the list goes on. Page 3 of 13 Episode 1 The Med Thread Show Transcript Insomnia: You’re Getting Sleepy MC: Plus, medications can cause insomnia so look out for drug-causes like stimulants, steroids and others and of course caffeine. That coffee or tea in the afternoon (or evening) can be a big culprit for keeping us awake whether we want it to or not. Don’t forget alcohol! We heard earlier that about 5% of us have used alcohol to get to sleep but this isn’t a quick fix. Alcohol affects our sleep quality and even though you might feel groggy and able to get to sleep it often leads to restless nights CB: and that horrendous morning hangover! MC: And we haven’t even started to look at medications that can affect sleep. Opioids is a big problem; taking it with sleeping medications can cause cumulative sedation which can affect breathing. A review I found, lists over 100 drugs that can impact sleep in various ways. They looked at sleep architecture, so the quality and stages of sleep.