What I wish I had known

November 28, 2022

3 minute read


Doghramji reports that he serves on the advisory board of Bayer, Biohaven, Eisai and Idorsia and on the speakers bureau of Amgen, Axome, Eisai, Idorsia and Merch. It also reports shares in CVS and Pfizer.

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I have been a primary care provider for 37 years now, but I still remember my early days in residency well.

In 1985 it made me nervous when a patient shared that he was having trouble sleeping because I wasn’t sure how to proceed and make sure I was doing the right thing for my patient. , in part because of the limited training I received in medicine. school and residence on sleep – not to mention insomnia. I looked to other doctors for advice, but the best approach to treating a patient with insomnia was really nebulous and unclear to all of us. At the time, information about insomnia and research on treatment options was limited, leading us to rely on medications for anxiety and depression, often resulting in unwanted side effects.

Paul P. Doghramji, MD, FAAFP

Despite the profound impact that insomnia has on the nights and days of people with sleep disorders (PWTS), such as their daily routines, jobs and relationships, patients often do not share with their providers when they struggle with insomnia. And if they do, it’s often after they’ve already tried to improve their sleep on their own. If I could go back, I would like to better understand the science behind insomnia, as well as the treatment options available, including the benefits and limitations of sleep hygiene, and what questions to ask patients to get a full picture of their insomnia. This knowledge would have made me feel more confident to start conversations with my patients about their sleep and treat them effectively.

The impact of insomnia is more urgent than ever, as we have seen rates rise during the COVID-19 pandemic. As the most common sleep/wake disorder, insomnia affects approximately 25 million adults in the United States. The DSM-5 defines insomnia as a combination of difficulty getting adequate sleep and dissatisfaction with sleep combined with a significant negative impact on daytime functioning for at least 3 nights per week over a 3 month period. month. We continue to learn the impact that poor quality and/or insufficient sleep caused by insomnia can have on daily life, including ability to concentrate, mood and energy levels, as well as more serious health consequences such as depression, cardiovascular disease, type 2 diabetes, dementia and obesity.

To help increase awareness and education around insomnia, I joined The Alliance for Sleep, a multidisciplinary group of sleep experts (sponsored by Idorsia US) that focuses on advancing research, raising the standard of care and improving health and quality. of life for those who suffer from insomnia. With my own experience as a primary care physician, I can appreciate the importance of providing more education – for healthcare providers (HCPs) and patients – about the science of insomnia, the impact about the day and the importance of treating insomnia for improving overall patient health.

One of the Sleep Alliance’s first initiatives was the Wake Up America: The Night & Day Impact of Insomnia survey, the largest US survey of PWTS and healthcare professionals. The results revealed that despite the surplus of information available about sleep, misconceptions about insomnia continue to be believed, both by the general public and by our colleagues in the healthcare communities. Additionally, the results revealed that PWTS either believed or was unsure of lies such as: your body can get used to functioning with less sleep (63%); naps can make up for lost sleep (61%); all prescription sleeping pills work the same way (44%); and you can make up for lost sleep another night (43%).

On the healthcare professional side of the same survey, 93% of primary care providers said that better sleep hygiene is often the best solution for treating insomnia. I have found that my colleagues are often surprised that this is not true. According to the guidelines of the American Academy of Sleep Medicine, sleep hygiene alone is not an effective treatment for insomnia. Once insomnia sets in, it will take more than just sleep hygiene to help your patients. This is one of the reasons I continue to promote sleep and insomnia education in healthcare professional communities with The Alliance for Sleep.

As we spend a third of our lives doing this, I strongly believe that as healthcare professionals, we can never be too knowledgeable about sleep. And while the best way to help our patients is to educate us, it’s also important that we take the time during our visits to ask patients questions about their sleep, including whether it’s impacting their day.


Alimoradi Z, et al. ECMedicineClinical. 2021; doi:10.1016/j.eclinm.2021.100916.

Bhaskar S, et al. Fam Med Prim treatment Round. 2016;doi:10.4103/2249-4863.201153.

by Almondes KM, et al. J Psychiatrist Res. 2016; doi:10.1016/j.jpsychires.2016.02.021.

Diagnostic and Statistical Manual of Mental Disorders (5th ed.) 2013; doi:10.1176/appi.books.9780890425596.

Dogramji K. Am J Manage care. 2006 May;12(8 Suppl): S214-20. PMID: 16686591.

Idorsia. https://www.idorsia.com/. Accessed November 5, 2022.

Olfson M, et al. J Clin Psychiatry. 2018; doi:10.4088/JCP.17m12020.

Roth T. J Clin Sleep Med. 2007; doi:10.5664/jcsm.26929.

Schutte-Rodin S, et al. J. Clin Sleep Med. 2008; doi: 10.5664/jcsm.27286.

Wake up America. https://www.wakeupamericasurvey.com. Accessed November 5, 2022.

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