What is your opinion of dispensing a one-time dose of Ambien to patients when they are unable to sleep during their sleep study? If so, do you have a policy or protocol for this?
This is a very interesting and important question, the answer to which depends greatly on the type of sleep center and laboratory operations. At our center, one-time dispensing of a sleep aid rarely arises, because we specialize in treating mental health patients with sleep disorders, most of whom present to our facility already using over-the-counter or prescription sleep aids. As we always encourage patients to undergo testing by simulating their home behaviors, most patients use their currently prescribed or selected sleep aids.
When we are helping patients with a chief complaint of insomnia who do not use sleep aids and who need sleep testing to evaluate sleep-disordered breathing or periodic limb movements, we prefer that no medications be used. We elect this approach, because we have created a sleep lab environment to actually assess and treat the insomnia on that night of testing. For example, we created a somewhat cozy environment that encourages patients to think about embracing a “sacred chamber” model for their own bedrooms. So, our rooms are not equipped with television sets, even though many insomniacs watch TV in bed before going to sleep. We also have two small lounge areas for a sleepless patient to visit instead of lying awake in bed frozen to the mattress. In one area, we offer multiple picture books on art, architecture, landscapes, and golf courses for patients to view in comfortable, overstuffed chairs or a sofa. In the other area, the patient sits at a small desk and spends time on a 500 or 1,000 piece puzzle, a technique we discovered has considerable potency for those who report difficulties in using our imagery-based (mind’s eye) distraction techniques.
In contrast to these approaches, other sleep centers may need a more expedient approach to the problem of managing patients’ fears or anxieties about sleeping in the lab. And, although I remain skeptical of the few research reports on the use of sleep aids in the laboratory environment, for example to help achieve sufficient hours of testing or to facilitate sleep when first exposed to PAP therapy, I agree that on a case-by-case basis, it is important to work directly with such patients before the scheduled lab appointment to develop a suitable plan.
Recently, I learned that Classic Sleepcare is looking at a newer supplement known as a sleepceutical, which might be useful to address this type of problem. The specific agent is known as Glysonna, and anecdotally I have heard of a number of cases in which patients reported good outcomes with this product, albeit at this point the supplement has not been investigated in a randomized controlled trial.
Finally, for the above reasons, we do not use a strict protocol to manage the issue of sleeplessness in the lab. I would be most uncomfortable establishing a “standing doctor’s order” to address this problem. Our system of handling the issue case-by-case has worked fairly well. Less than once per year will we encounter a patient who arrives at the lab and then abruptly leaves, which may be due to many factors. Naturally, we see a very small proportion of patients who may awaken early and request to terminate the study. Most of these patients, however, when using either of our lounge areas usually return to the bedroom and fall asleep again.
If we were going to institute a protocol, then we would probably move in the direction of using something like a sleepceutical, where presumably the potential for side-effects would be extremely low in contrast to the risks of prescription sleep medications. We have begun trying out the product with a few patients and hope to learn more about it. Interested individuals can receive samples through this contact email: firstname.lastname@example.org.