This blog post features useful tips for treating patients with insomnia, offered by Dr. John Crosby, an OntarioMD (OMD) Physician Peer Leader and practicing family physician in Cambridge, Ontario.
OMD offers a variety of blog posts to support clinicians with digital health tips and tools for varying skill levels. Content is tailored towards clinicians’ diverse needs, and articles may range from beginner to immediate and advanced users.
Getting a restful night’s sleep is a habit, and it takes repetition to break bad habits and create good ones.
Whenever patients tell me they have difficulties going to sleep at night or waking up early morning—or both—I take a planned approach to help them build a better habit, and support their needs as best as possible. I also leverage the benefits of my computer to make sure each visit is consistent, and nothing is missed.
I use PS TELUS EMR, but this can be something you can adapt to other EMRs. Here is how I use my EMR to treat patients with insomnia.
I have a stamp in my system (see below), which I insert into my chart on the day of the appointment. While interacting with the patient, I fill in the stamp using the prompts.
Together, we review everything on the plan list. Then I print it off, hand it to them, and let them know we will go through the plan line by line the next time we meet, in about one week.
Below is an example of the stamp and plan list. Note, discussions around caffeine and naps are often hot topics during appointments. I do insist that it’s always best to avoid caffeine and napping entirely, if patients are up for the challenge.
My “Stamp” for Insomnia
Subjective: How long?
Trouble getting to sleep or early morning awakening or both?
Objective:
Assessment:
Plan:
- No caffeine ever. Slowly wean yourself from coffee, tea, cola, chocolate, energy drinks.
- No napping ever. Go for a walk.
- Cool Room. 15 degrees Celsius.
- Buy a good bed, it’s 33% of your life.
- Go to bed at the same time each night.
- No alcohol. It makes you wake up in the middle of the night.
- If your brain is churning, write down all your worries.
- If you can’t sleep after 10 minutes, get up and go to another room. Read a boring book, drink warm milk, colour with Sharpie markers, have a warm bath.
- If your bed mate snores, go to another room.
- Get rid of your alarm clock.
- Avoid screens and exercise 2 hours before bedtime.
Other helpful hints: look up ‘4-7-8 breathing exercises’ for an effective sleep technique, and view more information on symptoms and causes of insomnia from the Mayo Clinic.
Dr. Chandrasena, OMD’s Chief Medical Officer who presents regularly to physicians about useful medical apps, suggests the website mysleepwell, which gives patients access to information about CBT-I and several other recommendations. There are also numerous apps available for insomnia such as AbilitiCBT (myicbt.com/programs) and CBT-i Coach.
I also advise patients on how to conduct a body scan for sleep: begin by bringing your attention into your body, and closing your eyes. Feel the weight of your body on the bed. Take ten deep breaths in through your nose, and out through your mouth. Notice your feet on the bed, and the sensations of your feet touching the bed—the weight, pressure, vibration and heat. You can notice your legs against the bed—the pressure, pulsing, heaviness, and lightness. Notice your back against the bed—the pressure, pulsing, heaviness, lightness. Now bring your attention to your stomach area. If your stomach is tense, let it soften. Take a breath. Notice your arms, feel any sensation in them. Let your shoulders soften. Notice your neck and throat. Let them be soft. Relax. Notice your whole body being present. Repeat.
I do this entire process at every appointment until my patients are better, and a good sleep becomes merely a force of habit. Using my EMR to facilitate the process repeatedly, and with consistency during patient interactions, is key to a favourable outcome.
For questions about EMRs and support with digital health and virtual care tools for your practice, contact support@ontariomd.com and connect with OMD’s expert staff and clinician Peer Leaders.
