The gold standard of treatment

GPs are the primary point of contact for patients presenting with insomnia and are well positioned to provide psychological interventions. Considered the gold standard, cognitive behavioural therapy (CBT-I) is recommended as the first-line treatment approach. However, in most cases patients are being given a prescription for a pharmacological treatment, predominantly benzodiazepine receptor agonists (BZRAs). Long-term use of such medications increases the risk of dependence and other harms such as cognitive deficits, falls, risk of motor vehicle accidents, and worse sleep quality.

Willing to try 

Recent research has found that patients are willing to engage with psychological interventions such as CBT-I but need support from their GP. The study, titled ‘Let’s talk about sleep health’ within primary care: a qualitative study of patients’ willingness to engage in psychological interventions for insomnia’ spoke to long-time sufferers of insomnia to understand their motivations and barriers to engaging in these types of interventions. Read the full article here: https://doi.org/10.3399/BJGP.2023.0310

Co-authors Associate Professor Petra Staiger and Dr Erin Oldenhof from Reconnexion speak to the British Journal of General Practice about their findings on sleep health within primary care and what can be done to reduce reliance on BZRA prescriptions for insomnia.

Psychological interventions for insomnia, such as CBT-I, have been found to produce both short and longer-term improvements in symptoms, and reduced reliance on prescription medications. The study highlights key factors that influence a patients intention to engage in psychological interventions and opportunities for GPs to support their uptake and engagement.

So, what do we do?

Findings from the study informed the development of key provider-based recommendations around how GPs can best respond to patients presenting with insomnia and encourage earlier uptake and engagement with psychological interventions. The recommendations include routinely initiating conversations about sleep, raising awareness of the impact of untreated insomnia and collaborating with sleep health practitioners.

The study highlights that while GPs are well placed to promote psychological interventions and move away from prescribing BZRAs, increasing uptake of psychological interventions will need collaboration between the patient, GP, sleep specialists and support from broader systems to ensure we all get a good night’s sleep.

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