Clinical management
Sleep restriction therapy better than sleep hygiene advice
Access to first-line treatment for insomnia, CBTI, is limited. A randomised controlled trial investigated the clinical and cost-effectiveness of sleep restriction therapy (a key component of CBTI) versus sleep hygiene advice for insomnia.
642 adults with insomnia disorder were recruited from 35 general practices across England and randomly assigned (1:1) using a web-based randomisation programme to either four sessions of nurse-delivered sleep restriction therapy plus a sleep hygiene booklet or a sleep hygiene booklet only.
At 6 months, participants in the sleep restriction therapy group reported lower insomnia severity than the sleep hygiene group (mean Insomnia Severity Index score was 10·9 (SD 5·5) for sleep restriction therapy and 13·9 (5·2) for sleep hygiene). Treatment was found likely to be cost effective.
Brief nurse-delivered sleep restriction therapy in primary care reduces insomnia symptoms, and has the potential to be widely implemented as a first-line treatment for insomnia disorder.
WiseGP Action
If available, recommend patients access CBTI locally. Alternatively, you could signpost patients to Sleepio, an online version of CBTI, in which sleep restriction is a core component. You can also explore if Sleepstation is funded for patients in your area.
Explore our WiseGP newsletter on insomnia for tips on how to take a whole person approach to supporting people with sleep problems.
Promoting CBT-I for insomnia
Cognitive behavioural therapy for insomnia (CBT-I) is underutilised in general practice.
An Australian qualitative study explored factors influencing participants’ intention to engage with psychological interventions (PIs) for insomnia. 20 adults participated in an interview.
Family/ friends positively supported engagement with PIs for insomnia. Hesitance by GPs to prescribe medication prompted some to explore PIs as an alternative. Some perceived GPs to lack confidence and/ or knowledge in PIs for insomnia to actively promote them.
WiseGP Approach
Reflect on how well you explain different psychological interventions- do your patients understand how therapies go beyond the support a relative or trusted friend might offer?
Read about what CBT-I involves, so you are able to explain more about this approach to support engagement. Here’s a useful link: https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia
Read about the research informing this GEM here: https://bjgp.org/content/74/745/e560
