Open Access
Feature Article

Insomnia treatment. Improved access to effective nondrug options

ALEXANDER SWEETMAN, NICOLE LOVATO, JENNY HAYCOCK, Leon Lack
Already a subscriber? Login here for full access.
Full Text: PDF

Figures

© AMENIC181/ISTOCKPHOTO.COM model used for illustrative purposes only
© AMENIC181/ISTOCKPHOTO.COM model used for illustrative purposes only

Abstract

Insomnia is a common disorder managed in Australian general practice. The RACGP recommends cognitive and behavioural therapy for insomnia (CBTi) strategies as the first-line treatment. There are multiple simple and effective CBTi options accessible to Australian general practitioners and patients, but these are often underused.

Key Points

  • Insomnia is a common, debilitating and costly disorder managed in Australian general practice.
  • Sedative-hypnotic medications are associated with potential side effects, adverse events and long-term dependence and are a suboptimal management strategy.
  • The RACGP recommends cognitive and behavioural therapy for insomnia (CBTi) strategies as first-line treatment.
  • Australian general practitioners can access multiple CBTi strategies, including effective self-administered, online, nurse- or GP-administered CBTi, or pathways for referral to a psychologist trained in treating insomnia.
  • An NHMRC research program is underway to explore whether the management of insomnia in general practice can be improved in line with RACGP guidelines. GPs interested in participating in this research are encouraged to contact the authors (contact@ncshsr.com).

Chronic insomnia is characterised by difficulties initiating or maintaining sleep, with associated daytime impairments, lasting for at least three months.1 Insomnia is the most common sleep disorder and impairs the lives of 10 to 30% of the Australian population, which, at a conservative estimate, equates to 2.5 million people. It costs Australia $11 billion annually due to its negative impacts on physical and mental health, healthcare costs and reduced productivity.2 Insomnia is a risk factor for depression and anxiety and contributes to 2.5- and twofold increases in motor vehicle and workplace accidents, respectively.3,4 

Advertisement

Chronic insomnia is well recognised to be perpetuated by underlying psychological or behavioural causes. These require strategic behavioural and cognitive modifications to break the cycle of poor sleep habits and self-fulfilling worry about chronic poor sleep. However, 90% of patients presenting to general practice with insomnia are prescribed sedative-hypnotic medications, with a quarter of a million Australians consuming these medications each night, despite widespread recognition that this is suboptimal clinical practice.5,6 Patients seeking treatment often expect to receive sedative-hypnotic medications (e.g. temazepam, diazepam, zolpidem, zopiclone), which are quick to prescribe but are associated with high rates of adverse cognitive and psychomotor side effects. These include adverse physiological effects; a heightened risk of hepatic, renal, respiratory and cardiac disorders; daytime sedation; cognitive impairments; an increased risk of falls among the elderly; and the development of dependence and withdrawal effects after long-term use.7,8

Pages

Figures

© AMENIC181/ISTOCKPHOTO.COM model used for illustrative purposes only
© AMENIC181/ISTOCKPHOTO.COM model used for illustrative purposes only
Dr Sweetman and Dr Lovato are joint first authors.
Dr Sweetman is a Research Associate at the Adelaide Institute for Sleep Health and the National Centre for Sleep Health Services Research, Flinders University, Adelaide. Dr Lovato is a Senior Research Fellow at the Adelaide Institute for Sleep Health and the National Centre for Sleep Health Services Research, Flinders University, Adelaide. Ms Haycock is a PhD Candidate at the Adelaide Institute for Sleep Health and the National Centre for Sleep Health Services Research, Flinders University, Adelaide. Professor Lack is an Emeritus Professor in the College of Education, Psychology and Social Work and the National Centre for Sleep Health Services Research, Flinders University, Adelaide, SA.