Improving the primary care management of insomnia

Prof A Niroshan Siriwardena
University of Lincoln
Innovative Deployment of Technologies

Summary

Insomnia affects 30% of adults every year, 10% having chronic symptoms leading to impaired quality of life, work absence, poor performance and economic consequences. The effects of insomnia are often compounded by adverse effects of hypnotic (sleep inducing) drugs. There is longstanding evidence of inappropriate prescribing of hypnotic drugs in primary care: hypnotics are prescribed to 10% of adults and 25% of those aged over 65 years in the UK. Previous advice fails to highlight to general practitioners (GPs) alternatives to drugs. A central theme of the research centre’s activity is translational research relating to quality improvement in health and social care, using various methods to investigate how to improve care provision through innovation, quality improvement and service redesign and to evaluate the effects of interventions designed to bring about improvement.

What are the Aims?

Our research aims to understand and improve primary care management of insomnia and sleep problems.

Who was/is involved?

The research was conducted by members of the Community and Health Research Unit (CaHRU) together with service users and visiting academics.

What has changed/will change?

Around 40% of patients suffer side effects to hypnotic drugs; 50% tried to stop taking them, often unsuccessfully and 20% still wanted to stop. Despite practitioners’ reluctance to recommend psychological treatments for insomnia, patients are open to these approaches A novel approach to managing sleep problems in primary care was developed as part of the study. This involved using careful assessment and patient focussed therapy, including cognitive behavioural treatment. Initial studies show that both patients and staff are more satisfied with the new approach and that there are significant reductions in hypnotic prescribing in general practices.

Although psychological therapy for insomnia is considered to be safer than drugs we have conducted the first study worldwide showing the adverse effects of sleep restriction therapy, a component of cognitive behavioural therapy for insomnia.

What lessons have we learnt?

Our research has led to broad improvements in healthcare provision for insomnia, improved patient quality of life, informed national/international policy and practice in insomnia care and impacted directly on health professional practice and insomnia sufferers through changes in sleep management, initially in Lincolnshire, spreading across the UK and internationally from 2008 to 2011. Direct effects on practice include changes in sleep management and reduced hypnotic prescribing through seminars, workshops, conferences and e-learning developed by the team; inclusion in UK policy, practitioner information, training materials and guidance on hypnotics have led to greater professional and public awareness of sleep management.

The research has changed public and professional awareness as well as professional policy and practice, by contributing to a better understanding of deficiencies in care and by developing and testing methods which have improved delivery of care for sleep problems and insomnia, which have improved quality of life for patients. It has had a direct benefit on primary care (general practitioners, practice nurses and primary healthcare team) and provision for patients with insomnia and sleep problems. Service users, the public and health practitioners have been involved in the conception, design and dissemination of the work.

Our team have developed an online e-learning resource to provide information and education to practitioners.  In the first two years of operation there were over 4,000 visits from more than 3,000 unique visitors, who spent on average 4.5 minutes on the site from 90 countries across all five continents (data from Google analytics). We have had very positive feedback from GPs in the UK and internationally including direct feedback on how they will use the learning in day-to-day practice. This includes the citation and recommendation to use the e-learning tool by GPs in New Zealand through prescribing guidance.

There is also greater public awareness of the work through information available to the general public through the press and online media. The paper by (Huedo-Medina et al BMJ 2012:345: e8343) received press and radio coverage in local (BBC Radio Lincolnshire), national (Times, Telegraph, Daily Mail, Radio5live) and international (US, Australasia, Asia) media.

Contact details

Professor Niro Siriwardena nsiriwardena@lincoln.ac.uk

Links to further information and resources

More information on this case study:
www.lincoln.ac.uk/home/research/researchshowcase/improvingtreatmentforinsomniasufferers

Case study websites:
www.restproject.org.uk
elearning.restproject.org.uk