How do people use community pharmacies to manage sleep problems? A cross-sectional survey of pharmacy customers in England, UK
Authors: Bhardwaj K , Wilson L E , Boardman H F , Avery A J , Boyd M J , Wilson L E 
Published: November 2024

Abstract

Introduction
Insomnia and sleep problems have become increasingly common in the UK population, with research indicating a rise in the prevalence of sleep issues and the use of hypnotic medications1. Poor sleep can severely affect overall health and has been linked to cardiovascular disease, type 2 diabetes, and other conditions2. Community pharmacies are ideally positioned to advise people about sleep, but there is limited information about how people currently utilise them for sleep problems.

Aim
To understand how people use community pharmacies to manage problems with sleep

Methods
A researcher-administered questionnaire with customers at 16 community pharmacies in the East Midlands from the 6th to 25th of March 2023. People aged 18 and older were approached to take part. Survey questions included demographic information, general pharmacy use, and specific questions related to health-seeking advice for sleep problems. Responses were recorded using the Qualtrics survey platform and descriptive statistics derived using MS Excel. Ethical approval was given by the School of Pharmacy Research Ethics Committee at the University of Nottingham (2017-017er).

Results
13,127 customers were approached to take part, and 4,985 consented and completed the questionnaire (response rate = 38.0%). Two thirds of participants were female (66.3%), half were above the age of 50 years (51.1%), and the majority identified as white ethnicity (79.8%). Just under one-third of participants reported purchasing a medicine, herbal remedy, or other product to help with sleep in the past (28.2%), of which 81.8% had purchased from a community pharmacy. The most common medicines purchased were anti-histamines (43.7%), followed by herbal remedies (34.1%). Only 19.1% of participants had previously sought advice for a sleep problem, of which 64.9% had sought advice from a GP/other healthcare professional, and 29.2% had sought advice from a community pharmacy. The most common advice received from a community pharmacy was to use a medicine (32.2%), with the second most common being sleep hygiene/lifestyle advice (22.8%). The most common advice received from a GP was also to use a medicine (36.4%).

Discussion / Conclusion
A significant proportion of survey participants reported purchasing a medicine, herbal remedy, or other product to help with sleep from a community pharmacy, highlighting the significant role of pharmacies in managing sleep issues. However, considerably fewer customers had sought advice for their sleep problem, identifying a potential gap in care. Current national guidelines do not recommend medication as first-line treatment for insomnia, emphasising sleep hygiene and behavioural therapy, with no role for sedative anti-histamines3. Despite this, our survey indicated the most common advice focused on medicines. This suggests an opportunity for enhancing the education of healthcare professionals and improving public awareness of managing sleep problems. Whilst this survey involved a large number of participants, we recognise it may not be fully representative of the wider UK population or practice. Further analysis of this survey and interviews with customers and pharmacists would help understand how the role of community pharmacies in managing sleep could be further developed to improve care.

References
1. Calem M, Bisla J, Begum A, Dewey M, Bebbington PE, Brugha T, Cooper C, Jenkins R, Lindesay J, McManus S, Meltzer H, Spiers N, Weich S, Stewart R. Increased prevalence of insomnia and changes in hypnotics use in England over 15 years: analysis of the 1993, 2000, and 2007 National Psychiatric Morbidity Surveys. Sleep. 2012 Mar 1;35(3):377-84. doi: 10.5665/sleep.1700. PMID: 22379244; PMCID: PMC3274339.
2. Worley SL. The Extraordinary Importance of Sleep: The Detrimental Effects of Inadequate Sleep on Health and Public Safety Drive an Explosion of Sleep Research. P T. 2018 Dec;43(12):758-763. PMID: 30559589; PMCID: PMC6281147.
3. National Institute for Health and Care Excellence (2024) Insomnia Available at https://cks.nice.org.uk/topics/insomnia/ [Accessed 6 June 2024].