Medicalisation, pharmaceuticalisation, or both? Exploring the medical management of sleeplessness as insomnia (original) (raw)
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Health Expectations, 2013
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. Aim We aimed to explore health professionals' and patients' experiences and perceptions of the management of insomnia in primary care. Design We used a qualitative design and thematic approach. Setting Primary care in Nottinghamshire and Lincolnshire. Method 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 overthe-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. Conclusion 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.
BMC Family Practice
Background Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying asleep such that it causes significant daytime impairment. Current Australian general practice guidelines recommend cognitive behavioural therapy for insomnia (CBTi) as first line treatment for insomnia, however research suggests that most general practice consultations for insomnia result in a prescription for hypnotic or sedative medicines. Although the first point of contact for patients experiencing symptoms of insomnia is often general practice, little is known about the current role, experiences and capacity of Australian general practitioners to manage insomnia. This study aimed to address that gap by exploring the attitudes and opinions of general practitioners regarding insomnia management, to inform the development and implementation of new models of best practice insomnia care within general practice. Meth...
Sleep Medicine, Public Policy, and Public Health (1994)
Sleep and sleepiness are among the most basic of human behaviors. As amply illustrated in chapters throughout this text , sleep can be disrupted not only by pathological processes but also by mismanagement and abuse. When sleep disruption occurs, regardless of the reason, the consequences for the individual and , in some circumstances, for society can be serious. At present , there is only limited recognition of this fundamental fact and of the vast gulf that still exists between gains in the scientific and medical knowledge of sleep and the application of these gains to prevention of personal and public catastrophes. The act of falling asleep at an inopportune time, regardless of the reason, has wreaked havoc on industrialized societies and will continue to do so. Sleep specialists constitute an important public policy resource because they have the relevant scientific and medic l expertise to affect public policy and reduce unsafe practices associated with sleep and sleepiness. Unfortunately, awareness and use of current knowledge about sleep have been hampered by a certain ''academic" reticence among sleep specialists to get involved in politics and by a public perception that sleep is one of those things that need not be taken too seriously when it come to health and safety. Yet , health professionals have always had a major role in decisions regarding public health issues. One does not have to look far to find cogent examples of behavioral and societal changes that were initiated by and through the health care system. These changes have, in turn, reduced the prevalence of catastrophic outcomes. Physicians and surgeons advanced the knowledge of linkages between "unseen" microbes and disease, which led to improvements in food preparation and waste disposal. Pulmonologists led the way in reducing cigarette smoking. Emergency room physicians helped implement mandatory seat belt laws. These and many other public health iniktiatives have saved millions of lives. Given what sleep specialists have learned about the effects of sleepiness on public safety, is it not now time for sleep specialist to lead in the formulation of public policy on sleepiness? It ca n be argued that sleepiness is another "unseen" threat to public health. Just as massive and long-term public educational efforts and government regulations are fundamental components of modern sanitation policy, for example. We must plan f'or similar educational and regulatory efforts to modernize policy concerning sleep. The purpose or this chapter is to define the areas in which the principles of sleep medicine can constructively shape public policy and improve public health.
Insomnia Management in the Australian Primary Care Setting
Behavioral sleep medicine, 2017
Insomnia is one of the most prevalent and costly sleep disorders presenting in general practice, and when left untreated, has major health consequences. However, studies are limited on how general practitioners respond to this health issue, especially since the reconceptualization of insomnia in DSM 5. Therefore, the aim of this study was to explore how insomnia is diagnosed and treated in Australian general practices. Twenty-four (54% male) general practitioners were recruited throughout the greater Sydney metropolitan area in New South Wales using the professional network of research team members and snowballing technique. Participants were interviewed using a semi-structured interview guide. The audio-taped interviews were transcribed verbatim and a framework approach was used for analysis of transcribed data. Participant's responses highlighted that despite being a frequent presentation, insomnia is often trivialized with a low recognition rate in general practices. Lack of ...
Journal of Sleep Research, 2010
SUMMAR Y The aim of the current national survey of all general practitioners (GPs) practising in Norway was to explore assessment, treatment practice and perceived efficacy of treatment of sleep problems in general practice. A short questionnaire, including selfreport measures of the frequency and routines of treatment and assessment of sleep problems, was sent to all 4049 GPs in Norway, of whom 1465 (36.7%) provided valid responses. The prevalence of sleep problems among patients in general practice was estimated to be 11.2%, of which almost two-thirds were believed to be caused by a medical condition. Anamnestic information and blood tests were the most common assessment of sleep problems, whereas GPs rarely referred patients to allnight polysomnographic recording. Sleep hygiene advices were the most commonly used treatment strategy, whereas hypnotics were believed to have the best short-term efficacy. Antidepressives were considered to be the best option for long-term management of sleep problems. About one-third of the patients were prescribed benzodiazepines or ÔZ-drugsÕ for more than 6 months. This study demonstrates that sleep problems are recognized by GPs, but despite evidence that non-pharmacological treatment is superior in the long-term management of insomnia, the current study shows that hypnotics are still considered by GPs to be the most successful treatment.
Prescriptions and proscriptions: moralising sleep medicines
Sociology of health & illness, 2015
The pharmaceuticalisation of sleep is a contentious issue. Sleep medicines get a 'bad press' due to their potential for dependence and other side effects, including studies reporting increased mortality risks for long-term users. Yet relatively little qualitative social science research has been conducted into how people understand and negotiate their use/non-use of sleep medicines in the context of their everyday lives. This paper draws on focus group data collected in the UK to elicit collective views on and experiences of prescription hypnotics across different social contexts. Respondents, we show, drew on a range of moral repertoires which allowed them to present themselves and their relationships with hypnotics in different ways. Six distinct repertoires about hypnotic use are identified in this regard: the 'deserving' patient, the 'responsible' user, the 'compliant' patient, the 'addict', the 'sinful' user and the 'noble'...