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Medicated Sleep and Wakefulness Study

Feedback Event: Warwick University 5^th November 2014

The aims of the study were to compare and contrast GP and patient views on `medicating sleep’ in primary care.

Approximately 10 million prescriptions are issued for sleeping pills in the UK each year

The prescription of hypnotics is a politicised issue in the UK with measures in place to monitor and reduce the prescription of hypnotics in primary care. All of the sleeping pills currently available in the UK are only licensed for short term use only – no pharmaceuticals are licensed for long term treatment of insomnia due to lack of evidence for long term efficacy, risk of dependency and other side effects.

Following up on the role of supporting the delivery of patient focus groups and general practice clinician interviews on the above topic, came attendance at the Sleep, Medicines and Society Programme feedback held at the University of Warwick. Our participating practices were:

· Abbey Medical Centre

· Sherbourne Medical Centre

· Springfield Medical Centre

· Castle Medical Centre

· Jubilee Health Centre

· Henley Green Medical Centre

· Forum Health Centre.  

Data was drawn from semi-structured interviews with seven GPs and three focus groups with 12 chronic users of hypnotics.

How does your patient view insomnia and its treatment?

Patients hold multiple views about the aetiology of their insomnia and the impact of any pharmaceutical regime adopted. Personal ambivalence is characterised by conflicting wishes which make it difficult to decide how to act. GPs are ambivalent about whether to prescribe hypnotics or not, especially to chronic users; however chronic use of hypnotics was also a source of personal ambivalence for some patients.

The impact of medication on insomnia was of concern to both patients and clinicians and the associated stigma of hypnotics and their addictive properties of primary concern within the patient focus group sessions.  

Hypnotics are viewed as a temporary remedy rather than daily therapy and short term use is seen in more positive terms, with long term use associated with the negative aspects of hypnotic drug use.  Intermittent chronic use at a stable dose is seen as more acceptable than daily use or escalating doses.

Whilst prescribing nationally for hypnotics is flat-lining and is certainly viewed as much more short term treatment (2-4 weeks) there is an increase in anti-depressant medication. The availability of CBT, or talking therapies, as a viable treatment option is patchy around the country.