Trial aims to improve therapy access for insomnia

For management of insomnia, the RACGP’s guidelines recommend cognitive behavioural therapy as a first-line treatment.
 
However, GPs have reported limited access to cognitive behavioural therapy for insomnia (CBTi) treatment and referral pathways, with only around 1% of Australian adults with insomnia currently accessing CBTi.
 
This is despite Flinders University sleep expert Dr Alexander Sweetman telling newsGP that CBTi typically produces many benefits.
 
‘CBTi targets the underlying causes of insomnia, resulting in improvements that [last] for many months and years into the future,’ he said.
 
‘Furthermore, CBTi is an effective treatment in patients with comorbid mental and physical health problems.’
 
Modelled on the UK’s Sleepio program and approved by the RACGP National Research and Evaluation Ethics Committee, an Australian version of the Sleepio study was recently completed to improve referral pathways for CBTi and steer away from the option of medication for treating insomnia.
 
Now that the Australian Sleepio study is complete, co-author Dr Sweetman has launched a new implementation study for GPs, expanding on previous programs to improve access to sleep health resources.
 
‘I have started this new trial to continue providing the CBTi option to GPs and patients, rather than leaving them without any digital CBTi referral option now that the Sleepio study is complete,’ he said.
 
While there is clear evidence that many patients present to GPs with symptoms of insomnia, and GPs report that it is ‘an integral’ part of their practice, Dr Sweetman notes that there are barriers to assessing and managing the condition.
 
‘GPs have reported limited access to CBTi treatment and referral options,’ he said.
 
‘To improve GP access, we have developed a self-guided online CBTi program that is suitable for general practice patients.’
 
Another objective of the program, aligning with the Sleepio study and RACGP guidelines, is to reduce the need for medication to manage sleep issues.
 
Additionally, the recent release of the Australian Sleep Association’s ‘living guidelines’ for sleep health management in primary care provides GPs with up-to-date and comprehensive guidance on tailored clinical care and referral options for people with sleep issues – with CBTi included as an effective non-drug intervention.
 
Dr Sweetman says although it is a ‘similar’ trial to the Sleepio study, the new trial is designed to provide GPs with a more streamlined model of referring patients with insomnia.
 
‘This interactive program includes five weekly sessions that each last for 20–30 minutes,’ he said.
 
‘[We are] using a newly developed Australian digital CBTi program, allocating eligible patients to immediate access to digital CBTi, or after an eight-week waiting period – a randomised controlled trial condition – eight weeks of sleep education before digital CBTi.’
 
Unlike the Sleepio study, the Doctors Control Panel software is not being used for the new trial. GPs can refer patients through a static website and no practice software will be used to identify patients or send pre-appointment SMS alerts.
 
Dr Sweetman hopes the trial will improve access to CBTi throughout Australian general practice.
 
‘[As well as] improve patients’ sleep, daytime function and mental health,’ he said.
 
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CBTi cognitive behavioural therapy insomnia non-drug interventions sleep health