Author: Jenny Haycock
Haycock, Jenny, 2023 The Diagnosis and Management of Insomnia in Australia, Flinders University, College of Medicine and Public Health
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Insomnia is the most common sleep disorder in Australia impacting the lives of millions of people every day. Chronic insomnia is defined as frequent difficulty falling asleep or staying asleep, which causes significant daytime impairment for a period of at least three months. The recommended treatment for insomnia is Cognitive Behavioural Therapy for insomnia (CBTi) but most people do not receive this evidence-based treatment. Most general practitioners (GPs) currently prescribe hypnotic or sedative medications, which are associated with high rates of adverse side effects, development of dependence, and withdrawal effects. This thesis investigates why the discrepancy between clinical guidelines and clinical practice exists, identifies barriers to the management of insomnia from the perspectives of people living with insomnia, GPs and psychologists, and explores how the management of insomnia in Australia can be improved.
This mixed methods research project included four studies. Studies 1 and 2 included large surveys conducted online which investigated the current help seeking behaviours of people with insomnia in Australia. Findings indicated most people with current chronic insomnia symptoms in a large community sample did not have a previous diagnosis of insomnia. The most common help seeking behaviours for people with insomnia were adjusting sleep routines, relaxation, alcohol and sleep medication. The findings show that only 37% of people with insomnia discussed sleep with their GP in the past year, 9% discussed sleep with a psychologist, and less than 1% received treatment that included CBTi. Studies 3 and 4 included interviews with GPs and psychologists about the current management of insomnia. Findings from these qualitative studies identified barriers and opportunities to managing insomnia in Australia. These barriers include lack of training in CBTi for health professionals, a need for increased awareness of insomnia as a primary condition and use of mental health treatment plans for insomnia.
The results of these studies are combined in the final chapter to provide overall findings regarding the management of insomnia in Australia from the different perspectives of people with insomnia, GPs and psychologists. Three themes are identified: low priority of sleep, impaired knowledge and awareness, and inadequate access to care. Barriers to effective management of insomnia are also identified within each theme and are discussed from the different perspectives. Barriers include people with insomnia feeling helpless about improving their sleep, unawareness of psychological treatments for insomnia, other health conditions take priority, lack of training in CBTi and cost concerns. Finally, recommendations are made to improve access to evidence-based care for people with insomnia in Australia.
Keywords: Insomnia, sleep, CBTi, primary care, psychologist, general practitioner
Subject: Health Sciences thesis
Thesis type: Doctor of Philosophy
Completed: 2023
School: College of Medicine and Public Health
Supervisor: Associate Professor Nicole Lovato