Use of First-Line Treatment for Insomnia Low Among Adults With Mental Health Conditions

Among individuals with insomnia who have mental health conditions, discussions about sleep with health professions were relatively common, but the likelihood of these discussions translating into the use of first-line treatments to treat insomnia were low, according to the results of a study published in Nature and Science of Sleep.

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Insomnia is common worldwide, and its prevalence is notably higher among people with mental health conditions, among whom approximately 50% are reported to experience insomnia symptoms. There has been limited research on the frequency of discussions about their sleep habits with health professionals, in addition to a lack of literature about how different sleep treatments are accessed and which barriers hinder access to first-line treatments.

This secondary analysis of the Australian 2019 Sleep Health Foundation insomnia survey aimed to explore discussions with a health professional about sleep and the self-reported use of sleep treatments for adults with insomnia who have mental health conditions.

The sample of participants were mostly female (62.2%), lived in a metropolitan area (65.4%), and were born in Australia (85.4%). The mean age of the sample was 43.6 years (standard deviation [SD] = 15.9).

In terms of socioeconomic status, the sample had similar proportions of disadvantaged (39.7%) and advantaged (38.6%) participants. Mental health difficulties were reported by 55.3% of individuals in the study, with 85.3% reporting feeling at least slightly anxious or depressed.

Around half (47.4%) of participants in the sample met the criteria for probable insomnia; 60.7% reported feeling sleepy during the day or early evening, 60.1% felt fatigued or exhausted, 52.4% reported difficulty falling asleep, and 60.3% reported waking during the night. Further, probable insomnia was more common in those with current mental health difficulties (53.9%) than those without (39.4%).

More than half of the sample reported discussing sleep habits at least once in the past 12 months (n = 327, 52.4%), with 28% (n = 174) speaking once to a health professional, and 25% (n = 153) more than once. Discussions were mostly reported with general practitioners and psychologists. The main reasons for discussing sleep were feeling unwell emotionally (n = 173, 52.9%) and having awareness of feeling sleepy or unfocused (n = 140, 42.8%).

Moving on to insomnia treatments, a greater proportion of participants reported using prescribed medication (n = 168, 26.9%) in comparison to cognitive-behavioral therapy for insomnia (CBTi) techniques (n = 72, 11.5%). Within those who met the criteria for probable insomnia, 35.1% (n = 104) indicated that they had been prescribed medication to help their sleep.

Individuals who did not receive consultation from a psychologist or psychiatrist but met the criteria for probable insomnia (n = 232), 127 (54.7%) provided an indication of reasons for non-engagement, according to the study authors. The most common reason was cost concerns, followed by general practitioners not raising psychological treatment as a possibility.

Treatment for insomnia has been shown to improve various mental health symptoms, which implies that addressing sleep-related issues can have beneficial effects on both sleep and other mental health presentations, the investigators wrote. Due to this, they say there is still room for improvement in terms of the rates of discussions about sleep among those with probable insomnia.

The investigators discussed some reasons for the lack of translation from discussions with health care providers to treatment. They include constraints in time and funding for individual general practitioners, insufficient referral pathways, and the complexities associated with co-occurring mental health issues.

“It is crucial to raise awareness of the importance of sleep and the benefits of evidence-based treatments, as well as to update clinical guidelines to highlight the need for routine sleep discussions and provide clear referral pathways,” the study authors concluded.

Reference

Russell DI, Reynolds AC, Appleton SL, et al. Use of insomnia treatments and discussions about sleep with health professionals among Australian adults with mental health conditions. Nat Sci Sleep. 2023;15:623-637. doi:10.2147/NSS.S412468