Professor Niroshan Siriwardena highlights the relevant recommendations for primary care from the British Association of Psychopharmacology guideline on insomnia and sleep disorders

siriwardena niro

Read the related Guidelines summary

Implementation actions for STPs and ICSs

written by Dr David Jenner, GP, Cullompton, Devon

The following implementation actions are designed to support STPs and ICSs with the challenges involved with implementing new guidance at a system level. Our aim is to help you consider how to deliver improvements to healthcare within the available resources.

Insomnia is a common problem but rarely catered for adequately by current NHS provision.

  • Explore the possibility of providing a web-based facility to provide support for GPs and patients, with simple programmes to facilitate self-help:
    • embed in this facility sleep assessment tools for people to use directly; these tools could also help to assess the severity of sleep problems so that people needing medical assessment can be identified
  • Ensure  that specialist services are available for GPs to refer to for more specialist problems and conditions, e.g. sleep apnoea
  • Consider contracting with commercial online providers that can provide a subscription-based sleep assessment and self-help services.

STP=sustainability and transformation partnership; ICS=integrated care system

References

  1. Morphy H, Dunn K, Lewis M et al. Epidemiology of insomnia: a longitudinal study in a UK population. Sleep 2007; 30  (3): 274–280.
  2. Reynolds C, O’Hara R, Morin C et al. Sleep-wake disorders. In: Schultz S, Kuhl E, editors. Diagnostic and statistical manual of mental disorders, fifth edition—DSM-5. Arlington: American Psychiatric Association, 2013.
  3. Wilson S, Anderson K, Baldwin D et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. J Psychopharmacol 2019; 33 (8): 923–947.
  4. Blank M, Zhang J, Lamers F et al. Health correlates of insomnia symptoms and comorbid mental disorders in a nationally representative sample of US adolescents. Sleep 2015; 38 (2): 197–204.
  5. World Health Organization. International statistical classification of diseases and related health problems—10th revision (ICD-10). 2016. icd.who.int/browse10/2016/en (accessed 18 December 2019).
  6. American Academy of Sleep Medicine. International classification of sleep disorders, third edition. Darien: AASM, 2014.
  7. Bastien C, Vallières A, Morin C. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2001; 2 (4): 297–307.
  8. Luik A, Machado P, Siriwardena N, Espie C. Screening for insomnia in primary care: using a two-item version of the Sleep Condition Indicator. Br J Gen Pract 2019; 69 (679): 79–80.
  9. Wilson S, Nutt D, Alford C et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol 2010; 24 (11): 1577–1601.
  10. Davidson J, Dickson C, Han H. Cognitive behavioural treatment for insomnia in primary care: a systematic review of sleep outcomes. Br J Gen Pract 2019; 69 (686): e657–e664.
  11. Mitchell M, Gehrman P, Perlis M, Umscheid C. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Pract 2012; 13: 40.
  12. Sleepio website. www.sleepio.com (accessed 20 December 2019).
  13. Belanger L, LeBlanc M, Morin C. Cognitive behavioral therapy for insomnia in older adults. Cogn Behav Pract 2012; 19 (1): 101–115.
  14. Walker, Matthew P. Caffeine, jet lag, and melatonin—losing and gaining control of your sleep rhythm. In: Welch S, Belden K, editors. Why we sleep: unlocking the power of sleep and dreams. New York: Scribner, 2017: 13–37.
  15. NICE. Insomnia. Clinical Knowledge Summary. Available at: cks.nice.org.uk/insomnia
  16. Lemoine P, Nir T, Laudon M, Zisapel N. Prolonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. J Sleep Res 2007; 16 (4): 372–380.