Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Primary Care
Published in: BMC Primary Care 1/2020

Open Access 01-12-2020 | Insomnia | Research article

Clinician and patient barriers to the recognition of insomnia in family practice: a narrative summary of reported literature analysed using the theoretical domains framework

Authors: Rowan P. Ogeil, Samantha P. Chakraborty, Alan C. Young, Dan I. Lubman

Published in: BMC Primary Care | Issue 1/2020

Login to get access

Abstract

Background

Insomnia is a common sleep complaint, with 10% of adults in the general population experiencing insomnia disorder, defined as lasting longer than three months in DSM-5. Up to 50% of patients attending family practice experience insomnia, however despite this, symptoms of insomnia are not often screened for, or discussed within this setting. We aimed to examine barriers to the assessment and diagnosis of insomnia in family practice from both the clinician and patient perspective.

Methods

The present article identified research that has examined barriers to assessing insomnia from the clinician’s and the client’s perspectives following MEDLINE and Google Scholar searches, and then classified these barriers using the theoretical domains framework.

Results

The most common barriers from the clinician’s perspective were related to Knowledge, Skills, and the Environmental Context. From the patient perspective, barriers identified included their Beliefs about the consequences of Insomnia, Social Influences, and Behavioural Regulation of Symptoms.

Conclusions

Utilising this theoretical framework, we discuss options for bridging the gap between the identification and subsequent management of insomnia within the family practice setting. To assist clinicians and those in community health care to overcome the Knowledge and Skills barriers identified, this article provides existing relevant clinical criteria that can be utilised to make a valid diagnosis of insomnia.
Literature
1.
American Academy of Sleep Medicine, editor. International classification of sleep disorders. 3rd ed. Darien: American Academy of Sleep Medicine; 2014.
2.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.CrossRef
3.
Wilson SJ, Nutt DJ, Alford C, Argyropoulos SV, Baldwin DS, Bateson AN, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: an update. J Psychopharmacol. 2019;33:8.CrossRef
4.
Morin CM, LeBlanc M, Daley M, Gregoire JP, Merette C. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med. 2006;7:123–30.PubMedCrossRef
5.
Riemann D, Bagilioni C, Bassetti C, Bjorvatn B, Dolenc Groselj L, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res. 2017;26:675–700.PubMedCrossRef
6.
Bartlett DJ, Marshall NS, Williams A, Grunstein RR. Predictors of primary medical care consultation for sleep disorders. Sleep Med. 2008;9:857–64.PubMedCrossRef
7.
Ohayon MM. Epidemiological overview of sleep disorders in the general population. Sleep Med Res. 2011;2:1–9.CrossRef
8.
9.
Dyas JV, Apekey TA, Tilling M, Ørner R, Middleton H, Siriwardena AN. Patients’ and clinicians’ experiences of consultations in primary care for sleep problems and insomnia: a focus group study. Br J Gen Pract. 60:e180–200.CrossRef
10.
11.
Ozminkowski RJ, Wang S, Walsh JK. The direct and indirect costs of untreated insomnia in adults in the United States. Sleep. 2007;30:263–73.PubMedCrossRef
12.
Kessler RC, Berglund PA, Coulouvrat C, Hajak G, Roth T, Shahly V, Shillington AC, Stephenson JJ, Walsh JK. Insomnia and the performance of US Workers: results from the America insomnia survey. Sleep. 2011;34:1161–71.PubMedPubMedCentralCrossRef
13.
Mansfield DR, Hillman DR, Antic NA, McEvoy RD, Rajaratnam SMW. Sleep loss and sleep disorders: shedding light on common but under-recognised individual and community problems. Med J Aust. 2013;199:S5–6.PubMed
14.
Arroll B, Fernando A, Falloon K, Goodyear-Smith F, Samaranayake C, Warman G. Prevalence of causes of insomnia in primary care: a cross-sectional study. Br J Gen Pract. 2012;62:e99–103.PubMedPubMedCentralCrossRef
15.
Bjorvatn B, Meland E, Flo E, Mildestvedt T. High prevalence of insomnia and hypnotic use in patients visiting their general practitioner. Fam Pract. 2017;34:20–4.PubMedCrossRef
16.
Cunnington D. Non-benzodiazepine hypnotics: do they work for insomnia? BMJ. 2013;346:e8699.CrossRef
17.
Dement W, Netzer N. Primary care: is it the setting to address sleep disorders? Sleep Breath. 2000;4:1–9.PubMedCrossRef
18.
Kushida CA, Nichols DA, Simon RD, Young T, Grauke JH, Britzmann JB, Hyde PR, Dement WC. Symptom-based prevalence of sleep disorders in an adult primary care population. Sleep Breath. 2000;4:9–14.PubMedCrossRef
19.
Senthilvel E, Auckley D, Dasarathy J. Evaluation of sleep disorders in the primary care setting: history taking compared to questionnaires. J Clin Sleep Med. 2011;7:41–8.PubMedPubMedCentral
20.
Ramakrishnan K. Treatment options for insomnia. S Af Fam Pract. 2007;49:34–41.
21.
Cunnington D, Junge MF, Fernando AT. Insomnia: prevalence, consequences and effective treatment. Med J Aust. 2013;199:S36–40.PubMedCrossRef
22.
Hassed C, Antoniades J, Jones K, Rajaratnam S, Kiropolous L. An examination of Australian general practitioners’ knowledge, attitudes and practices in relation to sleep disorders. Malays Fam Phys. 2012;7:16–23.
23.
Cranney M, Warren E, Barton S, Gardner K, Walley T. Why do GPs not implement evidence-based guidelines? A descriptive study. Fam Pract. 2001;18:359–63.PubMedCrossRef
24.
Zwolsman S, tePas E, Hooft L, Wieringa-deWaard M, van Dijk N. Barriers to GPs’ use of evidence-based medicine: a systematic review. Br J Clin Pract. 2012;62:511–21.
25.
26.
Rosen RC, Zozula R, Jahn EG, Carson JL. Low rates of recognition of sleep disorders in primary care: comparison of a community-based versus clinical academic setting. Sleep Med. 2001;2:47–55.PubMedCrossRef
27.
Bailes S, Baltzan M, Rizzo D, Fichten CS, Grad R, Wolkove N, Creti L, Amsel R, Libman E. Sleep disorder symptoms are common and unspoken in Canadian general practice. Fam Pract. 2009;26:294–300.PubMedCrossRef
28.
Miles A, Asbridge JE. The European Society for Person Centered Healthcare (ESPCH) – raising the bar of health care quality in the Century of the Patient. J Eval Clin Pract. 2014;20:729–33.PubMedCrossRef
29.
Birken AA, Powell BJ, Shea C, Haines ER, Kirk MA, Leeman J, et al. Criteria for selecting implementation science theories and frameworks: results from an international survey. Implement Sci. 2017;12:124.PubMedPubMedCentralCrossRef
30.
Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health. 2010;31:399–418.PubMedCrossRef
31.
Atkins L, Francis J, Islam R, O’Connor D, Patey A, Ivers N, et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12:77.PubMedPubMedCentralCrossRef
32.
Beenstock J, Sniehotta FF, White M, Bell R, Milne EMG, Araujo-Soares V. What helps and hinders midwives in engaging with pregnant women about stopping smoking? A cross-sectional survey of perceived implementation difficulties among midwives in the North East of England. Implement Sci. 2012;7:36.PubMedPubMedCentralCrossRef
33.
Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. BMJ Qual Saf. 2005;14:26–33.CrossRef
34.
Yamada J, Potestion ML, Cave AJ, Sharpe H, Johnson DW, Patey AM, Presseau J, Grimshaw JM. Using the theoretical domains framework to identify barriers and enablers to pediatric asthma management in primary care settings. J Asthma. 2017;20:1–14.
35.
Ferrari R. Writing narrative style literature reviews. Med Writ. 2015;24:230–5.CrossRef
36.
Aikens JE, Rouse ME. Help-seeking for insomnia among adult patients in primary care. J Am B Fam Pract. 2005;18:257–61.CrossRef
37.
Orr WC, Stahl ML, Dement WC, Reddington D. Physician education in sleep disorders. J Med Educ. 1980;55:367–9.PubMed
38.
Hohagen F, Rink K, Käppler C, Schramm E, Riemann D, Weyerer S, Berger M. Prevalence and treatment of insomnia in general practice. A longitudinal study. Eur Arch Psychiatry Clin Neurosci. 1993;242(6):329–36.PubMedCrossRef
39.
Hohagen F, Käppler C, Schramm E, Rink K, Weyerer S, Riemann D, Berger M. Prevalence of insomnia in elderly general practice attenders and the current treatment modalities. Acta Psychiatr Scand. 1994;90:102–8.PubMedCrossRef
40.
Haponik EF, Frye AW, Richards B, Wymer A, Hinds A, Pearce K, McCall V, Konen J. Sleep history is neglected diagnostic information. Challenges for primary care physicians. J Gen Intern Med. 1996;11:759–61.PubMedCrossRef
41.
Papp KK, Penrod CE, Strohl KP. Knowledge and attitudes of primary care physicians toward sleep and sleep disorders. Sleep Breath. 2002;6:103–9.PubMedCrossRef
42.
Siriwardena AN, Apekey T, Tilling M, Dyas JV, Middleton H, Ørner R. General practitioners’ preferences for managing insomnia and opportunities for reducing hypnotic prescribing. J Eval Clin Pract. 2010;16:731–7.PubMedCrossRef
43.
Cheung JM, Atternas K, Melchior M, Marshall NS, Fois RA, Saini B. Primary health care practitioner perspectives on the management of insomnia: a pilot study. Aust J Prim Health. 2014;20:103–12.PubMedCrossRef
44.
45.
Davy Z, Middlemass J, Siriwardena AN. Patients’ and clinicians’ experiences and perceptions of the primary care management of insomnia: qualitative study. Health Expect. 2013;18:1371–83.PubMedPubMedCentralCrossRef
46.
Omvik S, Pallesen S, Bjorvatn B, Sivertsen B, Havik OE, Nordhus IH. Patient characteristics and predictors of sleep medication use. Int J Clin Psychopharmacol. 2010;25:91–100.CrossRef
47.
Mindell JA, Bartle A, Wahab NA, Ahn Y, Ramamurthy MB, Huong HT, Kohyama J, Ruangdaraganon N, Sekartini R, Teng A, Goh DY. Sleep education in medical school curriculum: a glimpse across countries. Sleep Med. 2011;12:928–31.PubMedCrossRef
48.
Lu B, Budhiraja R, Parthasarathy S. Sedating medications and undiagnosed obstructive sleep apnea: physician determinants and patient consequences. J Clin Sleep Med. 2005;1:367–71.PubMed
49.
50.
Rosenberg RP. Sleep maintenance insomnia: strengths and weaknesses of current pharmacologic therapies. Ann Clin Psychiatry. 2006;18:49–56.PubMedCrossRef
51.
52.
53.
Rosen R, Zozula R. Education and training in the field of sleep medicine. Curr Opin Pulm Med. 2000;6:512–8.PubMedCrossRef
54.
55.
Holbrook AM, Crowther R, Lotter A, Cheng C, King D. The diagnosis and management of insomnia in clinical practice: a practical evidence-based approach. CMAJ. 2000;162:216–20.PubMedPubMedCentral
56.
Psychotropic Expert Group. Therapeutic guidelines: psychotropics. Melbourne: Therapeutic Guidelines Limited; 2013.
57.
Charles J, Harrison C, Britt H. Insomnia. Aust Fam Physician. 2009;38:283.PubMed
58.
Oxman AD, Thomson MA, Davis DA, Haynes RB. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ. 1995;15(153):1423–31.
59.
Wensing M, Van der Weijden T, Grol R. Implementing guidelines an innovations in general practice: which interventions are effective? Br J Gen Pract. 1998;48:991–7.PubMedPubMedCentral
60.
Ashworth DK, Sletten TL, Junge M, Simpson K, Clarke D, Cunnington D, Rajaratnam SMW. A randomized controlled trial of cognitive behavioral therapy for insomnia: an effective treatment for comorbid insomnia and depression. J Couns Psychol. 2015;62:115–23.PubMedCrossRef
61.
Falloon K, Elley CR, Fernando A, Lee AC, Arroll B. Simplified sleep restriction for insomnia in general practice: a randomised controlled trial. Br J Gen Pract. 2015;65:e508–15.PubMedPubMedCentralCrossRef
62.
Bandla H, Franco RA, Simpson D, Brennan K, McKanry J, Bragg D. Assessing learning outcomes and cost effectiveness of an online sleep curriculum for medical students. J Clin Sleep Med. 2012;8:439–43.PubMedPubMedCentral
63.
Zozula R, Rosen RC, Jahn EG, Engel SH. Recognition of sleep disorders in a community-based setting following an educational intervention. Sleep Med. 2005;6:55–61.PubMedCrossRef
64.
Van der Zweerde T, Lancee J, Slottje P, Bosmans J, van Someren E, Reynolds C, Cuipers P, van Straten A. Cost-effectiveness of i-Sleep, a guided online CBT intervention, for patients with insomnia in general practice: protocol of a pragmatic randomized controlled trial. BMC Psychiatry. 2016;16:85.
Metadata
Title
Clinician and patient barriers to the recognition of insomnia in family practice: a narrative summary of reported literature analysed using the theoretical domains framework
Authors
Rowan P. Ogeil
Samantha P. Chakraborty
Alan C. Young
Dan I. Lubman
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Insomnia
Published in
BMC Primary Care / Issue 1/2020
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-019-1070-0

Other articles of this Issue 1/2020

BMC Primary Care 1/2020 Go to the issue

Research article

Health mediators as members of multidisciplinary group practice: lessons learned from a primary health care model programme in Hungary

Research article

When is referral from primary care to specialist services appropriate for survivors of stroke? A modified RAND-appropriateness consensus study

Research article

Workload, diagnostic work-up and treatment of urinary tract infections in adults during out-of-hours primary care: a retrospective cohort study

Research article

Risk factors for a positive SARS-CoV-2 PCR in patients with common cold symptoms in a primary care setting – a retrospective analysis based on a joint documentation standard

Research article

Non-alcoholic fatty liver disease (NAFLD) and the cardiovascular disease (CVD) risk categories in primary care: is there an association?

Study protocol

Cooperation networks of ambulatory health care providers: exploration of mechanisms that influence coordination and uptake of recommended cardiovascular care (ExKoCare): a mixed-methods study protocol