The relationship of primary health care use with persistence of insomnia: a prospective cohort study

Richard A Hayward,Peter Croft,Kelvin P Jordan

doi:10.1186/1471-2296-13-8

Abstract

BackgroundPrevalence of insomnia symptoms in the general population is high. Insomnia is linked with high health care use and within primary care there are a number of treatment options available. The objective of this study was to determine the association of persistence and remission of insomnia with primary health care using a longitudinal study.MethodsA postal survey of registered adult (over 18 years) populations of five UK general practices, repeated after 1 year, linked to primary care records. Baseline survey responders were assessed for persistence of insomnia symptoms at 12 months. The association of primary care consultation or prescription for any mood disorder (defined as anxiety, depression, stress, neurosis, or insomnia) in the 12 months between baseline and follow-up surveys with persistence of insomnia was determined.Results474 participants reporting insomnia symptoms at baseline were followed up at 12 months. 131(28%) consulted for mood problem(s) or received a relevant prescription. Of these 100 (76%) still had insomnia symptoms at one year, compared with 227 (66%) of those with no contact with primary care for this condition (OR 1.37; 95% CI 0.83, 2.27). Prescription of hypnotics showed some evidence of association with persistence of insomnia at follow-up (OR 3.18; 95% CI 0.93, 10.92).ConclusionInsomniacs continue to have problems regardless of whether or not they have consulted their primary care clinician or received a prescription for medication over the year. Hypnotics may be associated with persistence of insomnia. Further research is needed to determine more effective methods of identifying and managing insomnia in primary care. There may however be a group who have unmet need such as depression who would benefit from seeking primary health care.

Highlights

Prevalence of insomnia symptoms in the general population is high
There are several studies which have examined the outcome in primary care for people presenting with insomnia, and in particular how this relates to management
Foley et al observed a persistence of insomnia symptoms of 52% in elderly patients in the community over a three year period, persistence being significantly and independently associated with physical disability, depression and sedative use [13]

Summary

Introduction

Prevalence of insomnia symptoms in the general population is high. Insomnia is linked with high health care use and within primary care there are a number of treatment options available. Simon et al in a community study with a 3 month telephone follow-up likewise found a positive association between insomnia and healthcare use, this appears to have been closely linked to depression [14]. There are a plethora of treatments available to primary care clinicians for the management of patients with insomnia, both pharmacological and non-pharmacological. This may bear testament to the fact that no treatment is both effective and without side effects, cognitive behavioural therapy and the melatonin agonist ramelteon appear promising [7,8,15,16,17,18]. Improvements in insomnia following CBT interventions delivered over the internet persisted at 6 month follow-up [18]

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Conclusion