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Independent pharmacists can play a key role in supporting patients struggling to have a good night’s sleep by providing tailored advice, accessible services and treatment recommendations. Steve Titmarsh reports…

Pharmacists with appropriate training can identify patients with sleep problems, such as insomnia or symptoms of sleep apnoea, through conversations and targeted screening tools.¹

For example, insomnia can be screened for and assessed using tools such as Insomnia severity index (ISI), Dysfunctional beliefs about sleep (DBAS-16), Epworth sleepiness scale (ESS) and Short Auckland sleep questionnaire for insomnia.²

Using evidence-based such assessments pharmacists can also determine if further referral or specialist intervention is needed.⁶

Triggers for insomnia

Insomnia can be triggered by a wide range of factors, both psychological and environmental, including:^3,4,5,6

– Stress and anxiety: Concerns about work, school, health, finances or family can keep the mind active at night, making it difficult to fall or stay asleep.

– Mental health: Depression, anxiety, and other mental health disorders are strongly linked to insomnia.

– Physical health: Chronic pain (such as arthritis or back pain), heart disease, asthma, acid reflux, overactive thyroid and other medical conditions can disrupt sleep.

– Medications: Some prescription drugs, including certain antidepressants, blood pressure medications and epilepsy treatments, may interfere with sleep.

– Sleep environment: Noise, light, an uncomfortable bed, or a room that is too hot or cold can prevent restful sleep.

– Irregular sleep schedule: Shift work, jet lag, or simply not keeping a consistent bedtime and wake-up time can disrupt the body’s internal clock.

– Poor sleep hygiene: Napping late in the day, using electronic devices before bed, eating heavy meals or spicy foods close to bedtime and using the bed for activities other than sleep.

– Stimulants and alcohol: Caffeine and nicotine can keep people awake, while alcohol disrupts sleep cycles and reduces sleep quality.

– Life events: Major life changes such as bereavement, job loss or other distressing events can trigger insomnia.

– Other sleep disorders: Conditions such as sleep apnoea, restless legs syndrome, or snoring can also lead to insomnia.

These triggers can interact, and insomnia often results from a combination of factors rather than a single cause.

There is a significant bidirectional link between stress and insomnia. Stress can disrupt sleep and poor-quality sleep can lead to greater sensitivity to stress and reduced resilience.^7,8

Chronic insomnia can also have an impact on a wide range of health issues. For example, insomnia suffered over a long period of time can be associated with or exacerbate diseases affecting the heart and lungs, the immune system and metabolism; it can also have an impact on mental health and the experience of chronic pain.^2,9

How medicines affect sleep

While they can improve sleep onset and duration, some medicines may also cause side effects such as dizziness, headaches, nausea, daytime drowsiness, confusion and memory problems.^10,11,12

Long-term use can lead to dependency, tolerance, withdrawal symptoms and may increase the risk of falls, especially in older adults.

Some medications, such as nicotine replacements, have been associated with unusual dreams or nightmares.¹⁰ Antidepressants such as fluoxetine, can be stimulating and make it harder to fall asleep, while others, like paroxetine, may be sedating.¹³

Beta blockers can reduce melatonin levels, making it difficult to fall or stay asleep. Corticosteroids often cause alertness or insomnia due to their stimulating effect.

Statins may cause muscle pain that disrupts sleep. Alzheimer’s drugs can lead to sleeplessness and bad dreams.¹² Some antihistamines may cause drowsiness but can also lead to grogginess the following day and impaired cognitive function, and even insomnia in some people.^14,15

Sleep hygiene and lifestyle advice

Pharmacists can offer practical, non-pharmacological advice on sleep hygiene, such as maintaining a regular sleep schedule, avoiding caffeine and alcohol before bed, and creating a restful environment (see Box 1).³

Sleep hygiene and behavioural therapy are recommended as first line treatments for insomnia.³

Pharmacists can educate patients about the importance of avoiding vigorous exercise close to bedtime and the risks of self-medicating with alcohol.³

Lifestyle and sleep hygiene advice³

– Advise patients to go to bed and wake up at the same time every day, even on weekends

– Go to bed when sleepy and avoid daytime naps

– Keep the bedroom cool, dark, and quiet; use the bed only for sleep and intimacy

– Avoid caffeine, nicotine, and alcohol close to bedtime

– Encourage relaxing activities before bed, such as reading or meditation

– Discourage use of electronic devices at least one hour before bedtime.

– Vigorous exercise is good during the day but should be avoided and hour or less before going to bed

Treatment recommendations

Pharmacists can recommend over-the-counter (OTC) sleep aids or herbal remedies if appropriate, while also cautioning about their limitations and potential side effects.¹

They should, however, reinforce that medication is not the first-line treatment for insomnia that has lasted less than three months and that sleep hygiene and behavioural therapies are preferred.³

If sleep hygiene or is not effective and a person is significantly distressed by lack of sleep, and their insomnia is caused by short-term stress, for example, so is likely to resolve in the near future, a 3–7-day course of non-benzodiazepine hypnotic medicine may be prescribed.

However, older people and pregnant women should not be prescribed these drugs. Other options include melatonin and daridorexant. ³

Cognitive behavioural therapy for insomnia should be offered in cases where daytime distress is significant and insomnia is unlikely to resolve soon. ³

Insomnia that has lasted more than three months may need specialist help from a sleep clinic, for example.

Valerian, hops and passiflora-based products may be considered for mild sleep disturbances. However, the evidence for the effectiveness of herbal remedies is variable and limited.^16,17

Deprescribing and medication review

Pharmacists can help optimise treatment for insomnia, including agreeing with GP colleagues on strategies to reduce the use of sedative medications, such as benzodiazepines, by supporting deprescribing initiatives and reviewing patients’ medication regimens.^2,18

Pharmacists can collaborate with GPs and other healthcare professionals to ensure patients receive comprehensive care and follow-up, especially when symptoms persist for more than a few weeks or suggest other conditions like sleep apnoea, narcolepsy, restless legs syndrome or mood disorders when medical referral would be indicated.

People in occupational at-risk groups such as professional drivers who have insomnia should also be referred for specialist medical help.^3,19

Education and ongoing support

Pharmacists can provide ongoing education about sleep monitoring and self-care, helping patients understand and track their sleep patterns.

They can offer leaflets, digital resources, and follow-up consultations to reinforce advice and encourage patients to return for further support.²

References

1. Rathbone AP. Early Intervention Community Sleep Support (EICSS) Report (https://bspss.org/service-eval/early-intervention-community-sleep-support-next-steps; accessed June 2025).

2. Ashkanani FZ, Lindsey L, Rathbone AP. A systematic review and thematic synthesis exploring the role of pharmacists in supporting better sleep health and managing sleep disorders. International Journal of Pharmacy Practice 2023;31:153–164.

3. Clinical Knowledge Summaries (CKS). Insomnia (https://cks.nice.org.uk/topics/insomnia; accessed June 2025).

4. NHSinform. Insomnia (www.nhsinform.scot/illnesses-and-conditions/mental-health/insomnia; accessed June 2025)

5. Sleep Foundation. What causes insomnia? (www.sleepfoundation.org/insomnia/what-causes-insomnia; accessed June 2025).

6. Patient.info. Insomnia (https://patient.info/doctor/insomnia; accessed June 2025).

7. Peszka J, Schomburg E, Scalzo K, et al. 0178 The Relationship of Sleep Hygiene, Sleepiness, and Sleep Quality to Mental Health (Burnout, Depression, Anxiety, and Stress) Among College Students. Sleep 2025;48 (Suppl 1):A80.

8. Yu X, Nollet M, Franks NP, et al. Sleep and the recovery from stress. Neuron 2025:S0896-6273(25)00311-3.

9. National Heart, Lung, and Blood Institute. Living with insomnia (www.nhlbi.nih.gov/health/insomnia/living-with#:~:text=Insomnia%20raises%20your%20risk%20of,or%20make%20existing%20problems%20worse; accessed July 2025).

10. Mayo Clinic. Prescription sleeping pills: what’s right for you? (www.mayoclinic.org/diseases-conditions/insomnia/in-depth/sleeping-pills/art-20043959; accessed June 2025).

11. Fitzgerald T, Vietri J. Residual Effects of Sleep Medications Are Commonly Reported and Associated with Impaired Patient-Reported Outcomes among Insomnia Patients in the United States. Sleep Disorders 2015;2015:607148.

12. WebMD. Is your medication affecting your sleep? (www.webmd.com/sleep-disorders/medications-that-affect-sleep; accessed June 2025).

13. Harvard Health. Are your medications keeping you up at night? (www.health.harvard.edu/diseases-and-conditions/are-your-medications-keeping-you-up-at-night; accessed June 2025).

14. Fitzgerald T, Vietri J. Residual Effects of Sleep Medications Are Commonly Reported and Associated with Impaired Patient-Reported Outcomes among Insomnia Patients in the United States. Sleep Disorders 2015;2015:607148.

15. Farzam K, Sabir S, O'Rourke MC. Antihistamines. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 (www.ncbi.nlm.nih.gov/books/NBK538188; accessed July 2025).

16. Guadagna S, Barattini DF, Rosu S, et al. Plant Extracts for Sleep Disturbances: A Systematic Review. Evidence Based Complementary Alternative Medicine 2020;2020:3792390.

17. Abraham O, Schleiden LJ, Brothers AL, et al. Managing sleep problems using non-prescription medications and the role of community pharmacists: older adults' perspectives. International Journal of Pharmacy Practice 2017;25(6):438–446.

18. Basheti MM, Gordon C, Grunstein R, et al. Exploring the pharmacist role in insomnia management and care provision: A scoping review. Journal of the American Pharmacists Association 2025;65:102312.

19. Bhardwaj K, Wilson LE, Boardman HF, t al. How do people use community pharmacies to manage sleep problems? A cross-sectional survey of pharmacy customers in England, UK. International Journal of Pharmacy Practice 2024;32 (Suppl 2):ii66–ii67.