Patients' and clinicians' experiences and perceptions of the primary care management of insomnia: qualitative study

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 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. 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.