GPs’ management strategies for patients with insomnia: a survey and qualitative interview study

Everitt, Hazel; McDermott, Lisa; Leydon, Geraldine; Yules, Harvey; Baldwin, David S.; Little, Paul

doi:10.3399/bjgp14x677176

Cited by 102 publications

(94 citation statements)

References 20 publications

(37 reference statements)

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“…Thus, GPs have a pivotal role in treating patients with insomnia. Despite this, available data indicate that GPs rarely prescribe or are able to offer CBT‐I to patients with insomnia (e.g., Everitt et al, ; Koffel et al, ). In the Netherlands, according to national GP standards, GPs should offer certain aspects of CBT‐I.…”

Section: Insomnia: Scope Of the Problem And Current Clinical Practicementioning

confidence: 99%

The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment

Baglioni

Altena

Bjorvatn

et al. 2019

Journal of Sleep Research

169

159

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Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT‐I) should be the first‐line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT‐I Academy that would enable a Europe‐wide system of standardized CBT‐I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT‐I, preconditions for health professionals to teach CBT‐I, the way in which CBT‐I should be taught, who should be taught CBT‐I and to whom CBT‐I should be administered. Furthermore, diverse aspects of CBT‐I care and delivery were discussed and incorporated into a stepped‐care model for insomnia.

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Section: Insomnia: Scope Of the Problem And Current Clinical Practicementioning

confidence: 99%

The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment

Baglioni

Altena

Bjorvatn

et al. 2019

Journal of Sleep Research

169

159

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“…Despite these moderate effects and the guideline recommendations, sleep medication is still the most commonly used treatment in general practice: 60% of new insomnia patients generally only receive medication [15]. Even though general practitioners (GPs) acknowledge the importance of CBT-I, they lack the time and/or knowledge to offer it themselves and there is a lack of CBT-I trained therapists to refer to [16]. Internet-delivered CBT-I (I-CBT-I) presents a promising way to increase the availability of CBT-I and to enable GPs to adhere to insomnia guideline recommendations.…”

Section: Introductionmentioning

confidence: 99%

Nurse-Guided Internet-Delivered Cognitive Behavioral Therapy for Insomnia in General Practice: Results from a Pragmatic Randomized Clinical Trial

Zweerde

Lancee

Slottje

et al. 2020

Psychother Psychosom

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Introduction: Guidelines recommend cognitive behavioral therapy for insomnia (CBT-I) as the first line of treatment for insomnia in general practice, but CBT-I is rarely available. Nurse-guided Internet-delivered CBT-I might be a solution to improve access to care. Objective: We aimed to determine the effectiveness of nurse-guided Internet-delivered CBT-I (I-CBT-I) on insomnia severity experienced by patients in general practice. Methods: Nurse-guided I-CBT-I (“i-Sleep”) was compared to care-as-usual (and I-CBT-I after 6 months) in 15 participating general practices among 134 patients (≥18 years old) with clinical insomnia symptoms. Assessments took place at 8, 26 and 52 weeks. Primary outcome was self-reported insomnia severity (Insomnia Severity Index) at 8 weeks. Secondary outcomes were sleep diary indices, depression and anxiety symptoms (Hospital Anxiety and Depression Scale), fatigue, daytime consequences of insomnia, sleep medication and adverse events. Results: Two thirds of the 69 intervention patients (n = 47; 68%) completed the whole intervention. At the posttest examination, there were large significant effects for insomnia severity (Cohen’s d =1.66), several sleep diary variables (wake after sleep onset, number of awakenings, terminal wakefulness, sleep efficiency, sleep quality) and depression. At 26 weeks there were still significant effects on insomnia severity (d = 1.02) and on total sleep time and sleep efficiency. No significant effects were observed for anxiety, fatigue, daily functioning or sleep medication. No adverse events were reported. Conclusions: Nurse-guided I-CBT-I effectively reduces insomnia severity among general practice patients. I-CBT-I enables general practitioners to offer effective insomnia care in accordance with the clinical guidelines.

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“…Promoting intermittent sedative hypnotic use in the management of insomnia is also complicated by a combination of health system and psychosocial factors including the limited access to cognitive behavioural therapy for insomnia (CBT‐I), the patients’ unique set of treatment beliefs (i.e. perceived medication need/usefulness for addressing insomnia) and what is communicated to the patient by their health‐care provider . These factors are likely to dictate whether or not the patient chooses to take, how they take their sleep medications and whether or not these medications are being used safely .…”

Section: Introductionmentioning

confidence: 99%

“…perceived medication need/usefulness for addressing insomnia) and what is communicated to the patient by their health-care provider. [24][25][26] These factors are likely to dictate whether or not the patient chooses to take, how they take their sleep medications and whether or not these medications are being used safely. 27 Therefore, the primary aim of this study was to explore patient beliefs and behavioural practices and their perception of sedation risk relating to the use of pharmacological and nonpharmacological sleep aids for insomnia.…”

Section: Introductionmentioning

confidence: 99%

People with insomnia: experiences with sedative hypnotics and risk perception

Cheung

Bartlett

Armour

et al. 2015

Health Expectations

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GPs’ management strategies for patients with insomnia: a survey and qualitative interview study

Abstract: Background

Cited by 102 publications

References 20 publications

The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment

The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment

Nurse-Guided Internet-Delivered Cognitive Behavioral Therapy for Insomnia in General Practice: Results from a Pragmatic Randomized Clinical Trial

People with insomnia: experiences with sedative hypnotics and risk perception

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