title: Patients' and clinicians' experiences and perceptions of the primary care management of insomnia: qualitative study.
abstract: BACKGROUND
  Insomnia is common leading to patients with sleep problems often presenting to primary care services including general practice, community pharmacies and community mental health teams. Little is known about how health professionals in primary care respond to patients with insomnia.
  
  
  OBJECTIVE
  We aimed to explore health professionals' and patients' experiences and perceptions of the management of insomnia in primary care.
  
  
  METHODS
  We used a qualitative design and thematic approach.
  
  
  METHODS
  Primary care in Nottinghamshire and Lincolnshire.
  
  
  METHODS
  We undertook focus groups and one-to-one interviews with a purposive sample of health professionals and adults with insomnia.
  
  
  RESULTS
  We interviewed 28 patients and 23 health professionals. Practitioners focused on treating the cause of insomnia rather than the insomnia itself. They described providing stepped care for insomnia, but this focused on sleep hygiene which patients often disregarded, rather than cognitive behavioural therapy for insomnia (CBT-I). Practitioners were ambivalent towards hypnotic drugs but often colluded with patients to prescribe to avoid confrontation or express empathy. Patients sometimes took hypnotics in ways that were not intended, for example together with over-the-counter medication. Practitioners and patients were sometimes but not always concerned about addiction. Practitioners sometimes prescribed despite these concerns but at other times withdrew hypnotics abruptly without treating insomnia. Both patients and practitioners wanted more options and better training for the management of insomnia in primary care.
  
  
  CONCLUSIONS
  A better understanding of the current approaches and difficulties in the management of insomnia will help to inform more therapeutic options and health professional training.
authors: School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK.
authors: Zowie
authors: Z
authors: Davy
authors: School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK.
authors: Jo
authors: J
authors: Middlemass
authors: School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK.
authors: Aloysius N
authors: AN
authors: Siriwardena
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology / Q000628:therapy*
keywords: cognitive behavioural therapy for insomnia; insomnia; prescribing practices; treatment
references: Sleep. 2007 Mar;30(3):263-73
references: 17425222
references: Sleep. 2002 Sep 15;25(6):625-9
references: 12224841
references: Soc Sci Med. 1999 Aug;49(4):459-67
references: 10414806
references: Sleep. 2007 Feb;30(2):213-8
references: 17326547
references: Br J Gen Pract. 2008 Jun;58(551):417-22
references: 18505619
references: Compr Psychiatry. 1998 Jul-Aug;39(4):185-97
references: 9675502
references: Am J Psychiatry. 1994 Aug;151(8):1172-80
references: 8037252
references: Br J Gen Pract. 2008 Feb;58(547):79-80
references: 18307848
references: Can Fam Physician. 2010 Nov;56(11):e398-406
references: 21075981
references: Can Fam Physician. 2007 Jul;53(7):1200-1
references: 17872818
references: Soc Sci Med. 2006 Mar;62(5):1237-49
references: 16143440
references: J Eval Clin Pract. 2010 Aug;16(4):731-7
references: 20545802
references: Br J Gen Pract. 2010 May;60(574):334-40
references: 20423585
references: Sleep. 2009 Dec;32(12):1549-58
references: 20041590
references: Arch Intern Med. 2011 May 23;171(10):895-6
references: 21263076
references: Soc Sci Med. 2005 Jul;61(1):133-55
references: 15847968
references: Wien Klin Wochenschr. 2010 Aug;122(15-16):474-8
references: 20658195
references: J Gen Intern Med. 2007 Mar;22(3):303-7
references: 17356959
references: Clin Psychol Rev. 2005 Jul;25(5):559-92
references: 15970367
references: Sleep. 2006 Nov;29(11):1398-414
references: 17162986
references: Health (London). 2007 Apr;11(2):181-98
references: 17344271
references: J R Coll Physicians Lond. 1998 Mar-Apr;32(2):149-53
references: 9597633
references: Scand J Prim Health Care. 2007 Dec;25(4):214-9
references: 18041658
references: BMJ. 2000 Jan 1;320(7226):50-2
references: 10617534
references: Br J Gen Pract. 2010 May;60(574):e180-200
references: 20423574
references: Behav Res Ther. 2002 Jan;40(1):75-83
references: 11762429
references: Fam Pract. 1992 Dec;9(4):466-71
references: 1490540
references: Sleep. 2010 May;33(5):585-92
references: 20469800
references: J Gen Intern Med. 2007 Aug;22(8):1094-100
references: 17492325
references: Sleep Med. 2006 Mar;7(2):123-30
references: 16459140
references: Eur Arch Psychiatry Clin Neurosci. 1993;242(6):329-36
references: 8323982
references: Sleep. 2007 Mar;30(3):274-80
references: 17425223
references: Fam Pract. 1997 Oct;14(5):361-8
references: 9472369
references: Aging Ment Health. 2004 May;8(3):242-8
references: 15203405
references: Sleep. 2006 Dec;29(12):1551-60
references: 17252886
references: Am J Psychiatry. 1997 Oct;154(10):1417-23
references: 9326825