Insomnia or Sleep Medication Tolerance

As my technician was processing a prescription the other day, she received an error message that indicated the patient she was typing the prescription for had recently filled a similar medication. This particular patient had been taking a sleep medication, and then had a new prescription for a different sleep medication from another physician.  The patient was not available in the store at the time to consult with, so I put in a phone call to the new physician.  I explained the situation; the patient had picked up a different sleep medication from his primary care physician only 5 days ago.  The new physician was unaware of this.

Evidently, the patient had gone to the new physician specifically for his sleep issue.  The new physician thanked me for the call and asked me to put a hold on the new medication until I heard back from him.  He stated that he would call the patient and discuss the process with him.  He let me know that he would be happy to handle the patients sleep medication therapy; however, only if he received all of his sleep medications from one doctor and one pharmacy.  He asked if I would take the time to call the patients primary care physician and explain the situation.  By the end of the day, it was all worked out and we were all on the same page. 

I don’t believe the patient was attempting to withhold any information from the pharmacy or the physician, the problem is that the patient was not sleeping well.  This particular patient had been receiving one particular sleep medication for some time and it had been progressively becoming less and less effective.  He then had an appointment with a sleep specialist who prescribed another medication to help him sleep.  At that point, it didn’t occur to the patient to let the physician know that he had just picked up the other sleep medication 5 days ago and has a full bottle of it at home. 

I appreciate when I have the opportunity to have a counseling session with a patient when it is their first time ever receiving a sleep medication.  We are able to discuss the concept that most sleep medications are indicated for short term treatment of insomnia and not indicated for daily dosing.  I explain that most of the medications used for sleep, with one or two exceptions, are used to help an individual fall asleep quicker, not necessarily keep them asleep longer.  We discuss the fact that if someone takes a sleep medication on a nightly basis for approximately 10 or more nights, the body becomes conditioned to the medication and it will be very difficult to fall asleep the next night without a sleep medication.

Most prescriptions for sleep medications are written to be taken “as needed” for sleep.  The “as needed” portion of the directions is where some reasonable pharmacist counseling should come in.  It is important for a patient to understand that if they want their medication to continue to work for them when they need it, it is a good idea to not take their sleep medication every night.   It is reasonable to use an “as needed” dose for a couple nights to get some good rest, and then try a night or two without the medication.  This “as needed” process helps keep the body from developing a tolerance to the sleep medication.

There are indications where the physician will have their patient take sleep medication on a nightly basis; however, when taken on a nightly basis, it is likely that the patient will develop a tolerance to the medication over time.  As tolerance develops, it will appear that the medication is not working as well and the patient may ask the doctor if they may increase the dose.  An increased dose may then be effective for some length time; however, tolerance may then build up and once again it will appear that the medication is not working as well. 

At this point, the patient may be asking their physician if there is any other medication they may try for sleep, or perhaps they may be referred to a sleep specialist.  For more information on what to do if you are unable to fall asleep at night or if you would like to learn about sleep hygiene, please read this previous blog I wrote about sleep.  If you would like to learn about any of the medications used to help people sleep, please register to becomea member of AudibleRxTM, and then have full access to all of the Medication Specific Counseling SessionsTM for a full five years.

Thanks
Steve

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