Benefits for patients & practitioners

Public health benefits

  • Sleep problems common
  • Association of poor sleep with psychological and physical ill health and mortality
  • Hypnotics do more harm than good in the elderly
  • Psychological treatments effective and safe and have long term benefits

Sleep problems are common affecting up to 30% of the adult population in any one year. One third of patients who develop insomnia will go onto develop long-term or recurrent problems with insomnia, so chronic insomnia affects 10% of the adults. Insomnia leads to reduced productivity and impaired health-related quality of life.

The average adult requires 6-9 hours sleep per day but this may vary with age, gender and health status. Getting less than this requirement may be associated with significant ill health which can be medical (i.e. weight gain, hypertension, type 2 diabetes), psychiatric (i.e. depression, anxiety) and psychological (low mood, reduced energy and performance, cognitive impairment and daytime sleepiness).

Although it’s true that there has been a gradual reduction in prescribing of benzodiazepines over the past decade…the use and cost of hypnotic drugs has not fallen in the past 10 years and is in fact increasing. Nowadays, in the UK over £22m is spent on 10 million (m) items of hypnotic drugs. The extent and cost of sleeping tablet prescribing has never come down. This is because older drugs have been replaced by newer more expensive Z drugs. Drug treatment has shown to be ineffective long term and probably does more harm than good, particularly in the elderly. Many of those whose lives are affected seek medical help from primary care.

Psychological treatments for sleep problems, including cognitive behavioural therapy for insomnia (CBTi) have been shown to be effective and cost effective but have not been widely implemented or evaluated in a general practice setting where they are most likely to be needed and most appropriately delivered.