Instead of reaching for a pill, more people should switch to the recommended ‘first line’ for insomnia – the non-drug option.
After exhaustive studies, the specially designed Cognitive Behavioural Therapy for insomnia (or ‘CBTi’) has been rated the most effective long-term solution for the common sleep condition – and Flinders University experts are calling for more GPs and psychologists to help roll it out in Australia.
While non-drug insomnia treatment is becoming more accessible for patients having trouble sleeping, it is still only accessed by 1% of people with insomnia, says Flinders University research fellow, Dr Alexander Sweetman.
“Sleep problems are among the most common reasons that patients present to their doctor in Australia,”
“Sleeping pills are still the mainstay management option for insomnia, despite a lot of evidence suggesting that behavioural treatments are much more effective in the long-term.
“CBTi is the most effective and recommended first line treatment for insomnia because it treats the underlying causes of long-term insomnia without drugs and hundreds of scientific studies have demonstrated its effectiveness.
“Improved access to this non-drug behavioural treatment in the Australian health system will relieve the difficulties faced by people with this common debilitating sleep disorder.”
The prevalence of chronic insomnia is about 10-15% in Australian adults at any given time. Short-term insomnia is more common, but can be related to many different causes and not always treated with CBTi.
Untreated insomnia is associated with increased risk of psychiatric conditions, hypertension, accidents and sick leave, and incurs high economic and societal costs through reduced quality of life, productivity and increased use of healthcare resources.
The researchers from Flinders University and the Sax Institute have published a five-year study in the international Journal of Clinical Sleep Medicine calling for more Australian health professionals to promote CBTi.
“GPs play a central role in Australia’s universal health care system,” says coauthor, Flinders University Emeritus Professor Doug McEvoy.
“They are often the first point of contact with patients engaging with the health system, screen and deliver care for many health conditions, and operate as ‘gate keepers’ for referral to specialist medical services.
“As a result, GPs were at the centre of our insomnia translation program to improve access to CBTi.
“We are urging more GPs and psychologists to access CBTi training resources, and offer evidence-based CBTi to people with insomnia symptoms – rather than drugs.”
The research includes ongoing collaborations with the SAX Institute, Australasian Sleep Association, Sleep Health Foundation, Australian Psychological Society, Royal Australian College of General Practitioners and other groups.
With this diverse group of stakeholders, the study resulted in six major recommendations, to:
• IMPROVE GP awareness of insomnia and CBTi
• RAISE awareness among GPs and psychologists of funding options to access CBTi
• DEVELOP GP education resources, including an online primary care insomnia management guideline
• ESTABLISH a psychologist CBTi training program in collaboration with the Australian Psychological Society and Australasian Sleep Association
• LAUNCH a GP CBTi training program at Flinders University Sleep Health in collaboration with the Royal Australian College of General Practitioners and the General Practice Mental Health Standards Collaboration.
• DEVELOP and test an interactive digital CBTi program.
Sleep expert Dr Jenny Haycock, whose doctoral studies at Flinders University were part of the five-year study, says:
“Most GPs interviewed were aware of the risks of long-term use of sleeping pills, but had very little knowledge of CBTi and how their patients could access it.
“There seems to be a readiness for change so I am optimistic that many more insomnia patients will be able to access this best-practice care with increased awareness of CBTi amongst GPs and their patients.”
Senior Flinders University respiratory and sleep physician, Professor Robert Adams, says new education and training opportunities will help to turn the tide.
“We encourage patients and their partners to ask their GPs about CBTi and join the Sleep Health Foundation and the Australasian Sleep Association in advocating to the Government for ways to improve Australians’ access to non-drug interventions,” concludes Professor Adams, who also worked on the latest article.
The article, ‘Promoting sustained access to cognitive behavioural therapy for insomnia (CBTi) in Australia: A system-level implementation program’ (2024) by Alexander Sweetman, R Doug McEvoy, Michael S Frommer, Robert Adams, Ching Li Chai-Coetzer, Sallie Newell, Vivienne Moxham-Hall and Sally Redman has been published in the Journal of Clinical Sleep Medicine DOI: 10.5664/jcsm.11374.
Acknowledgements: This study was supported by a National Health and Medical Research Council Centres of Research Excellence grant. As well as NHMRC funding, the study was supported by Flinders University, the SAX Institute, Australasian Sleep Association, Sleep Health Foundation, Royal Australian College of General Practitioners, Australian College of Rural and Remote Medicine, and Australian Psychological Society.
