Background

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Benefits for patients & practitioners
Hypnotic prescribing
Patient and practitioner views
How we developed the evidence
Self assessment

Patient and practitioner views

Practitioner Beliefs
What Patients Said
What Patients Need
What Practitioners Need to Understand

Practitioner beliefs about sleep

GPs did not like prescribing drugs but were not sure what else they could do or how to do this
Compared to anxiety where GPs tended to use or refer for psychological treatments for insomnia, drugs were often an early choice of treatment, particularly Z drugs over benzodiazepine hypnotics
GPs positive to initiatives to reduce inappropriate prescribing

GPs felt that prescribing hypnotics was appropriate in some circumstances. Overall GPs did not like prescribing hypnotics, particularly long term. However, whereas they tended to use psychological treatments for anxiety they often resorted to drugs for insomnia. They liked Z-drugs because they through they were more effective, less likely to cause side effects, tolerance and addiction – although there was little evidence for these beliefs. They were positive to initiatives to reduce inappropriate hypnotic prescribing.

References

Siriwardena AN, Qureshi Z, Gibson S et al. Family doctors’ attitudes and behaviour to benzodiazepine and Z drug prescribing. BJGP 2006; 56: 964-967.

Siriwardena AN et al. General practitioners’ preferences for managing insomnia and opportunities for reducing hypnotic prescribing. J Eval Clin Pract 2010;16: 731–737.

What patients told us about hypnotics

95% had taken hypnotics for 4 weeks or more
45% advised to continue treatment for a month or more and a further 42% not advised on duration
92.1% were on repeat prescriptions
87.9% first prescribed by GP
18.6% wished to stop medication

More than 90% of patients had taken the drug for 4 weeks or more contrary to the drug licence and current guidance.
More than 90% of patients had been advised to continue treatment for 4 weeks or not been advised on duration which is contrary to the short-term licence for these drugs. More than 90% of patients were on repeat prescriptions. Around 90% of patients first prescribed a hypnotic by their GP despite some GPs feeling that psychiatrists and others had started these drugs rather than the GP. At least one side effect was reported in 41.8% of patients. Around a fifth of patients (18.6%) wished to come off hypnotic medication; and 48.5% had tried to stop treatment.

References

Dyas JV, Apekey T, Tilling M, Orner R, Middleton H, Siriwardena AN. Patients’ and clinicians’ experiences of consultations in primary care for sleep problems and insomnia: a focus group study. BJGP 2010; 60: 329 -333.

What patients said they needed

Listening, empathy, taking the problem seriously
Health beliefs: concerns about sleep tablets vs. need for help
Previous self-help: what they have tried already: OTC, complementary
Careful assessment
Problem focused therapy: including CBT-i

Patients had tried to resolve insomnia themselves, often for months or years.

Consulting was often a last resort and by the time they consulted patients felt they needed to convince practitioners that their sleep difficulties were serious and that a sleeping tablet was the only available option.

References

Dyas JV, Apekey TA, Tilling M, Middleton H, Siriwardena AN. Patients’ and clinicians’ experiences of consultations in primary care for sleep problems and insomnia: a focus group study. BJGP 2010; 60: 329 -333.

What practitioners need to understand

Don’t assume that patients would always want or need a prescription
Many patients had tried non-drug treatments but not adequately or consistently
Patients are often open to alternatives

References

Dyas JV, Apekey TA, Tilling M, Middleton H, Siriwardena AN. Patients’ and clinicians’ experiences of consultations in primary care for sleep problems and insomnia: a focus group study. BJGP 2010; 60: 329 -333.