title: GPs' management strategies for patients with insomnia: a survey and qualitative interview study.
abstract: BACKGROUND
  Patients frequently experience sleep problems and present to primary care. However, information is limited regarding the management strategies that GPs employ.
  
  
  OBJECTIVE
  To gain an understanding of current GP management strategies for insomnia.
  
  
  METHODS
  A postal questionnaire survey and qualitative interviews with GPs in the south of England.
  
  
  METHODS
  A postal survey of 296 GPs and qualitative interviews were carried out with 23 of the GPs.
  
  
  RESULTS
  The survey response rate was 56% (166/296). GPs look for signs of depression and anxiety in patients and if present treat these first. 'Sleep hygiene' advice is provided by 88% (147/166) of GPs but often seems insufficient and they feel under pressure to prescribe. Benzodiazepines and Z drugs are prescribed, often reluctantly, for short periods, because of known problems with dependence and tolerance. Many GPs prescribe low-dose amitriptyline for insomnia although it is not licensed for this indication. For insomnia 95% (157/166) of survey responders 'ever prescribe' amitriptyline, with 31% (52/166) stating they do so commonly. Most GPs perceived amitriptyline to be effective and a longer-term option for those with ongoing sleep problems. GPs report a lack of knowledge and confidence in the provision and use of psychological therapies, such as cognitive behavioural therapy (CBT), in the management of insomnia.
  
  
  CONCLUSIONS
  GPs often find 'sleep hygiene' advice is insufficient for managing insomnia and report frequently prescribing medication, including amitriptyline (off licence), which is often based on perceived patient pressure for a prescription. Patients are rarely offered psychological therapies such as CBT for insomnia, despite evidence suggesting its potential effectiveness.
authors.affiliation: Primary Care and Public Health Sciences, Health and Social Care Research, School of Medicine, King's College London.
authors.forename: Hazel
authors.initials: H
authors.lastname: Everitt
authors.forename: Lisa
authors.initials: L
authors.lastname: McDermott
authors.forename: Geraldine
authors.initials: G
authors.lastname: Leydon
authors.forename: Harvey
authors.initials: H
authors.lastname: Yules
authors.forename: David
authors.initials: D
authors.lastname: Baldwin
authors.forename: Paul
authors.initials: P
authors.lastname: Little
mesh_terms: D000639:Amitriptyline / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D001007:Anxiety / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D001291:Attitude of Health Personnel; D001569:Benzodiazepines / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D019538:Health Care Surveys; D005102:Health Expenditures; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D036301:Qualitative Research; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D011795:Surveys and Questionnaires
chemical_list: D000929:Antidepressive Agents, Tricyclic; D001569:Benzodiazepines; D000639:Amitriptyline
keywords: amitriptyline; general practice; insomnia; management strategies