Abstract
Guidelines recommend cognitive behavioural therapy for insomnia (CBT-I) as first-line treatment for chronic insomnia, but it is not clear how many primary care physicians (PCPs) in Switzerland prescribe this treatment. We created a survey that asked PCPs how they would treat chronic insomnia and how much they knew about CBT-I. The survey included two case vignettes that described patients with chronic insomnia, one with and one without comorbid depression. PCPs also answered general questions about treating chronic insomnia and about CBT-I and CBT-I providers. Of the 820 Swiss PCPs we invited, 395 (48%) completed the survey (mean age 54years; 70% male); 87% of PCPs prescribed sleep hygiene and 65% phytopharmaceuticals for the patient who had only chronic insomnia; 95% prescribed antidepressants for the patient who had comorbid depression. In each case, 20% of PCPs prescribed benzodiazepines or benzodiazepine receptor agonists, 8% prescribed CBT-I, 68% said they knew little about CBT-I, and 78% did not know a CBT-I provider. In the clinical case vignettes, most PCPs treated chronic insomnia with phytopharmaceuticals and sleep hygiene despite their lack of efficacy, but PCPs rarely prescribed CBT-I, felt they knew little about it, and usually knew no CBT-I providers. PCPs need more information about the benefits of CBT-I and local CBT-I providers and dedicated initiatives to implement CBT-I in order to reduce the number of patients who are prescribed ineffective or potentially harmful medications.
Highlights
Chronic insomnia is common in industrialized countries; prevalence averages about 10%, though the number of affected people ranges from 6% to 19% in European countries (Calem et al, 2012; Leger, Guilleminault, Dreyfus, Delahaye, & Paillard, 2000; Marschall, Hildebrandt, Sydow, & Nolting, 2017)
The gap between insomnia treatment guidelines and primary care physicians (PCPs) practice in Europe is troubling and we aimed to investigate whether the trend was similar in Switzerland
We invited all Swiss PCPs working as medical student preceptors for the Institute of Primary Care at the University of Bern (BIHAM) and all PCPs who report for the Sentinella practice-based research network (PBRN) 1 led by the Federal Office of Public Health (BAG) to participate in a survey
Summary
Chronic insomnia is common in industrialized countries; prevalence averages about 10%, though the number of affected people ranges from 6% to 19% in European countries (Calem et al, 2012; Leger, Guilleminault, Dreyfus, Delahaye, & Paillard, 2000; Marschall, Hildebrandt, Sydow, & Nolting, 2017). DSM-5 defines chronic insomnia as subjective sleep disturbance at least 3 nights/week for at least 3 months, with concomitant daytime impairment (Association, 2013). It is associated with medical and psychiatric conditions like cardiovascular disease and depression (Baglioni, Spiegelhalder, Nissen, & Riemann, 2011; Li, Zhang, Hou, & Tang, 2014). Chronic insomnia and depression are closely linked: depressed patients usually have altered sleep and chronic insomnia patients have twice the risk of developing depression (Baglioni et al, 2011; Riemann, Krone, Wulff, & Nissen, 2020). The DSM-5 defines chronic insomnia independently from associated conditions and no longer distinguishes primary and secondary insomnia (Association, 2013)
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