Time Trends in the Family Physician Management of Insomnia: The Australian Experience (2000–2015)

Valenti, Lisa; Harrison, Christopher; Bartlett, Delwyn J.; Glozier, Nick; Cross, Nathan; Grunstein, Ronald R.; Britt, Helena; Marshall, Nathaniel S.

doi:10.5664/jcsm.6616

Cited by 45 publications

(38 citation statements)

References 24 publications

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“…The estimated prevalence of insomnia varies widely according to diagnostic criteria and specific populations of interest, however it is thought that 6%-10% of the general population suffer from chronic insomnia disorder, which includes clinically significant and frequent nocturnal sleep disturbances and impaired daytime functioning [6,7]. Although cognitive and behavioral therapy for insomnia (CBTi) leads to long-term improvement of insomnia and is the recommended 'first line' insomnia treatment [8][9][10][11], a lack of access to CBTi has resulted in the majority of insomnia sufferers receiving prescriptions for sedative-hypnotic medications as the initial and ongoing treatment [12,13].…”

Section: Insomnia and Obstructive Sleep Apneamentioning

confidence: 99%

Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials

2019

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Co-morbid insomnia and sleep apnea (COMISA) is a highly prevalent and debilitating disorder, which results in additive impairments to patients' sleep, daytime functioning, and quality of life, and complex diagnostic and treatment decisions for clinicians. Although the presence of COMISA was first recognized by Christian Guilleminault and colleagues in 1973, it received very little research attention for almost three decades, until the publication of two articles in 1999 and 2001 which collectively reported a 30%-50% co-morbid prevalence rate, and re-ignited research interest in the field. Since 1999, there has been an exponential increase in research documenting the high prevalence, common characteristics, treatment complexities, and bi-directional relationships of COMISA. Recent trials indicate that co-morbid insomnia symptoms may be treated with cognitive and behavioral therapy for insomnia, to increase acceptance and use of continuous positive airway pressure therapy. Hence, the treatment of COMISA appears to require nuanced diagnostic considerations, and multi-faceted treatment approaches provided by multi-disciplinary teams of psychologists and physicians. In this narrative review, we present a brief overview of the history of COMISA research, describe the importance of measuring and managing insomnia symptoms in the presence of sleep apnea, discuss important methodological and diagnostic considerations for COMISA, and review several recent randomized controlled trials investigating the combination of CBTi and CPAP therapy. We aim to provide clinicians with pragmatic suggestions and tools to identify, and manage this prevalent COMISA disorder in clinical settings, and discuss future avenues of research to progress the field.

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Section: Insomnia and Obstructive Sleep Apneamentioning

confidence: 99%

Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials

2019

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“…Although there has been a modest decline in the volume of benzodiazepine prescriptions dispensed annually, overall, there is still a high level of long‐term benzodiazepine use in Australia . For example, in the case of insomnia, almost 80% of patient presentations result in a prescription for benzodiazepine derivatives (such as temazepam, oxazepam, diazepam, and nitrazepam), and this figure has remained stable over the past 10 years …”

Section: Introductionmentioning

confidence: 99%

Benzodiazepine usage and patient preference for alternative therapies: A descriptive study

Sake

Wong

Bartlett

et al. 2019

Health Science Reports

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Background and aims The prevalence of chronic benzodiazepine use in primary care settings remains high despite clear evidence of adverse health outcomes resulting from long‐term use and the availability of effective alternative behavioural therapies. Eliciting factors influencing past or current usage experience of benzodiazepine users and their future behavioural intention regarding discontinuation or alternative behavioural therapy adoption could be useful in developing informed strategies facilitating successful benzodiazepine withdrawal in long‐term users. The aim of this study was to identify patient factors influencing their current long‐term benzodiazepine use, past withdrawal attempt, and future intention to trial safer alternative behavioural therapies. Additionally, the study also aimed to explore patients' preference for information sources on behavioural therapies. Methods Point of purchase surveys were conducted with patients obtaining benzodiazepines from selected pharmacies across New South Wales (NSW), Australia. Survey items included the Beliefs about Medicines Questionnaire (BMQ‐specific), questions about patient's sociodemographic characteristics, as well as their views about long‐term benzodiazepine use and behavioural therapies. Results Seventy‐five patients were recruited from 12 pharmacies across New South Wales (NSW). The surveys were conducted from November 2016 to July 2017. The mean (±SD) age of the participants was 54.3 (±16.7) with a range of 23 to 86 years, and 67% of the participants had been using the benzodiazepine for at least 1 year. Lower‐education levels, stronger beliefs about the necessity of use, and lower concerns about ongoing benzodiazepine use were significantly associated with prolonged use. Sixty‐four percent of the participants were not interested in behavioural therapies, and there was a significant relationship between the participants' future preference for behavioural therapies and their concerns about the potential adverse effects of benzodiazepines. A majority of the participants rated general practitioners (GPs) as their first choice and pharmacists as the second choice for discussing behavioural therapies. Conclusions Specific individual sociodemographic characteristics of benzodiazepine users and their medication‐related beliefs influence their current benzodiazepine usage and future intention to trial behavioural therapies as an alternative to their benzodiazepines. Based on the reported preferences of benzodiazepine users in this study, developing and evaluating GP‐pharmacist collaborative services to improve the uptake of behavioural therapies as an alternative to benzodiazepines can be recommended.

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“…All these factors strongly suggest that BZRAs and Z‐drugs should not be routinely used in older people without careful consideration of individual circumstances. Despite this, BZRAs and Z‐drugs continue to be commonly prescribed in Australia for sleep disturbances …”

Section: Adverse Effects Of Medications Commonly Used For Sleep Disormentioning

confidence: 99%

Treatment of sleep disturbance in older adults

Reynolds

Adams

2019

Pharmacy Practice and Res

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Sleep and circadian rhythm disturbances are prevalent in older populations. Numerous factors can affect sleep, including medications, living environment and physical, mental and psychosocial factors (e.g. loneliness and stress). Sleep architecture changes with aging, with less deep sleep (slow wave sleep) and an increased frequency of awakenings after sleep onset. Benzodiazepines, Z-drugs and low doses of the tricyclic antidepressant doxepin have modest positive benefits for sleep complaints, but side effects are a concern in older people because they include an increased risk of falls, fractures and cognitive impairment. Somnolence can be prolonged in older adults. Melatonin has very modest effects on sleep initiation in older adults, although appears safe. Overall, the effects of pharmacological treatments are modest and there are concerns about the efficacy and safety of their ongoing use. There is strong evidence for non-pharmacological interventions, including cognitive and behavioural strategies, to improve sleep. These have at least comparable efficacy to pharmacological interventions, fewer adverse effects and are more likely to have longer-term, sustained benefits. Sleep complaints in older adults need to be approached on a patient-by-patient basis, and medication should be reviewed frequently, with preference to limit pharmacological intervention as far as practicable.

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Time Trends in the Family Physician Management of Insomnia: The Australian Experience (2000–2015)

Cited by 45 publications

References 24 publications

Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials

Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials

Benzodiazepine usage and patient preference for alternative therapies: A descriptive study

Treatment of sleep disturbance in older adults

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