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Management of Insomnia in Female Patients - Episode 3

Quality of Life and Patient Communication Regarding Insomnia

An overview of the impact insomnia can have on female patient’s quality of life and how they communicate sleep disturbance concerns with health care professionals.

Charlene Gamadelo, MD: What’s the impact of insomnia on the individual? It’s becoming clear that insomnia has an impact on the night sleep experience and the day experience. From the standpoint of the night experience, insomnia is an inability to get to sleep, stay asleep, or wake up feeling rested and restored, despite having adequate opportunity to do so. There’s that impact on the night experience. That’s the focus of what we’ve done in terms of treatment, but we recognize that most patients come to see their doctor not because they were having a bad nighttime experience, but because it’s impacting their daytime functioning.

The list of ways this can happen is long and lengthy, but it can be from mood. At the far end, it can result in depression and anxiety. But from a more short-term standpoint, it can impact overall temperament, with you more likely to get in disagreements with family members and coworkers. You’re more likely to have less of an attention span. You’re more likely to make errors at work. This could be grave—for instance, if you’re in the health industry. There’s also presenteeism and absenteeism from work. From a personal safety standpoint, they’re more likely to have a car crash as a result of insomnia because of the poor sleep quality that you received.

For a woman, the impact that it can have on your day ranges. From a physical standpoint, with poor sleep at night, the pain threshold that somebody can tolerate during the day is less. How you feel in general can be impacted by insomnia. Socially and occupationally, how you interact with family, friends, and peers. Finally, from a public safety perspective, your ability to operate a car can be impacted if you suffer from insomnia.

The question most folks ask is, how often are sleep concerns discussed with health care providers? Because I’m a sleep doctor, everybody coming to see me is coming to discuss a sleep problem. But within the literature, it’s clear that we’re rarely the first stop for a patient, especially female patients who want to discuss sleep with their health care providers. First and foremost, the 2 most common are usually primary care providers followed by psychiatrists. There are discussions at times with women’s health doctors, ob-gyns. In most cases, it’s something specific related to a women’s health issue. For instance, if a pregnant patient is suffering from insomnia, they can see this as a state-related issue. Those are typically the most common areas where we see this. Second, it will come up in the discussion of symptoms of menopause. Other than that, there has been an association between sleep disruption and the menstrual cycle, premenstrual syndrome, that sort of thing. That’s rarely brought up within the discussions with health care providers, but it’s certainly an issue for many patients.

What are some of the barriers for why that happens? There are a few things, and it’s probably on both ends of the interaction between patient and provider. One is that from the patient perspective, only recently has there been growing awareness that lack of sleep is a medical issue and that patients shouldn’t see it as an annoyance that they can deal with on their own and shouldn’t bother their doctor with. That has gradually started to change. There’s been a bit more gumption from patients to discuss this with their health care providers. On the flip side, for health care providers who aren’t sleep doctors, there are more areas of health that they have to cover for their patients and sometimes in decreasing amounts of time. Although doctors—including the groups I talked about—have an increasing awareness of the interaction between their patient’s health and sleep, and they try to discuss it, it often becomes difficult because of the time constraints. Perhaps this is because of the limited tools to know how to do it in a succinct and direct way. This is an area and a gap that needs to be filled. The sleep community is trying to assist with that to see how we can help team up with health care providers who are seeing patients, especially women who are more likely to suffer from lack of sleep. How we can provide more education, more tools, so they can talk to their patients about it? They need to be able to identify when a patient needs to be seen by a sleep specialist, being direct and efficient.

Transcript Edited for Clarity