Treatment Options for Insomnia in the New Zealand Primary Care Setting: What do people find effective? Sarah Reid Karma Galyer Waikato Clinical School
Insomnia DSM-IV diagnosable insomnia: 5-6 % of general adult population (Ohayon, 2002). New Zealand Study - 25% reported sleep problem lasting 6 months duration (Paine, et al, 2004). Negative impact on daily functioning is well established(Mai & Buysse, 2008).
Assessment and intervention resources are limited. Medications e.g. hypnotics are the most accessible form of medication. Recommendations have been made for the development of alternative treatment options in primary care, particularly by psychologists (TSANZ, 2004). Insomnia: Management at Primary Care Level
Research Questions 1. How do people with chronic insomnia view the treatment options available to them? 2.What is the relationship between sleep beliefs and use of prescription medication for sleep? 3. What is the relationship between current treatment choice and current insomnia symptoms?
Treatment Choices for Sleep Problems Survey Treatment Choices for Sleep Problems Survey Data collection November 2010 – January 2011. Survey monkey online link. Posters and survey placed in: 16 medical centres. 16 pharmacies. 5 natural health provider. Hospital Sleep Clinic.
Measures Measures Athens Insomnia Scale (AIS) (Soldatos et al, 2000). Cut-off score of 6 = likely insomnia diagnosis. Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16) (Morin et al, 2007). Consequences Worry Medication Expectations Treatment Options Treatment options tried. Effect on sleep.
177 respondents reported a current sleep difficulty. 88% female 86% NZ/Other European. 8% Maori. 3% other. Respondents
2. What is the Relationship Between Sleep Beliefs and Use of Prescription Medication for Sleep?
Treatment Choices and Sleep Beliefs Figure 1: Relationship between prescription medication use and sleep beliefs.
3. What is the relationship between current treatment choice and current insomnia symptoms?
Treatment Choice and Insomnia Symptoms Figure 2: Relationship between current treatment choice and insomnia symptoms.
Conclusions Primary care patients are not accessing effective alternatives to medication. People using prescription medication for sleep had the greatest perceived current sleep difficulties. Consistent with previous research, sleep related beliefs impact treatment choice (e.g. Sanchez-Ortuno & Edinger, 2010). Greater endorsement of unhelpful sleep beliefs was related to longer term use of prescription medications.
Effective in a primary care setting (Edinger & Sampson, 2003). Effective in assisting patients cease chronic hypnotic medication use (Pat-Horenczyk, 1998). Changes in sleep beliefs through cognitive behavioural techniques resulted in maintained in sleep efficiency (Morin et al, 2002). Cognitive Behavioural Therapy for Insomnia
References Edinger, J. D., & Sampson, W. S. (2003). A primary care "friendly" cognitive behavioural insomnia therapy. Sleep, 26, 177-181. Mai, E. M., & Buysse, D. J. (2008). Insomnia: Prevalence, impact, pathogenesis, differential diagnosis, and evaluation. Sleep Medicine Clinics, 3,167-174. Morin, C. M., Blais, F., & Savard, J. (2002). Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia? Behavior Research and Therapy, 40, 741-752. Morin, C. M., Vallieres, A., & Ivers, H. (2007). Dysfunctional beliefs and attitudes about sleep (DBAS): Validation of a brief version (DBAS-16). Sleep, 30 (11), 1547-1554. Ohayon, M. M. (2002). Epidemiology of insomnia: What we know and what we still need to learn. Sleep Medicine Reviews, 6, 97-111. Paine, S. J., Gander, P. H., Harris, R., & Reid, P. (2004). Insomnia risk factors: implications for treatment services. Annual Scientific Meeting of the Australasian Sleep Association. Auckland, NZ, October 10-12th, 2003. Internal Medicine Journal, A20. Pat-Horenczyk, R. (1998). Changes in attitudes toward insomnia following cognitive intervention as part of a withdrawal treatment from hypnotics. Behavioural and Cognitive Psychotherapy, 29, 345-357. Sanchez-Ortuno, M. M., & Edinger, J. D. (2010). A penny for your thoughts: Patterns of sleep-related beliefs, insomnia symptoms and treatment outcome. Behaviour Research and Therapy, 48, 125-133. Soldatos, C. R., Dikeos, D. G., & Paparrigopoulos, T.J. (2000). Athens insomnia scale: Validation of an instrument based on ICD-10 criteria. Journal of Psychosomatic Research, 55, 263-267. Thoracic Society of Australia and New Zealand (2004). Standards for Adult Respiratory and Sleep Services in New Zealand. Retrieved 10 August, 2010, from http://www.moh.govt.nz/moh.nsf/pagesmh/3756?Open
Dysfunctional Beliefs and Attitudes about Sleep Scale Worry I am concerned that chronic insomnia may have serious consequences on my physical health. I am worried that I may lose control over my abilities to sleep. When I sleep poorly on one night, I know it will disturb my sleep schedule for the whole week. I can’t ever predict whether I’ll have a good or poor nights sleep. I have little ability to manage the negative consequences of disturbed sleep. I feel insomnia is ruining my ability to enjoy life and prevents me from doing what I want.
Expectations I need 8 hours of sleep to feel refreshed and function well during the day. If I don’t get the proper amount of sleep on a given night, I need to catch up on the next day by napping or on the next night by sleeping longer.
Dysfunctional Beliefs and Attitudes about Sleep Scale Consequences Without an adequate night’s sleep, I can hardly function the next day I avoid or cancel obligations (social, family) after a poor night’s sleep. When I feel irritable, depressed or anxious during the day, it is mostly because I did not sleep well the night before. When I feel tired, have no energy, or just seem not to function well during the day, it is generally because I did not sleep well the night before. After a poor night’s sleep, I know that it will interfere with my daily activities on the next day.
Medication Medication is probably the only solution to sleeplessness. I believe insomnia is essentially the result of a chemical imbalance. In order to be alert and function well during the day, I believe I would be better off taking a sleeping pill rather than having a poor nights sleep.