Opinion
Insomnia management pathways in rural general practice
A new study is testing online treatment for a common and debilitating condition, aiming to improve health outcomes and access equity.
A new study aims to reduce reliance on benzodiazepines for insomnia.
Getting access to psychological services is often difficult for people living in rural and regional Australia. To help address this, we are evaluating online treatment for a common and debilitating condition.
The RACGP is a project partner on new Medical Research Future Fund research that aims to investigate the effectiveness and uptake of a digital insomnia management program in rural and remote general practice. If successful, the program could help improve both outcomes and equity and reduce reliance on benzodiazepines.
More than 3.2 million Australian adults experience chronic insomnia at any given time, which is among the most common reasons that patients attend general practice consultations. Cognitive behavioural therapy for insomnia (CBTi) is the recommended ‘first line’ treatment for insomnia.
CBTi is effective in patients with comorbid mental and physical disorders, sleeping pill use, and when delivered in-person, via telehealth, and by digital CBTi programs. However, GPs have reported limited reimbursement structures, education opportunities, and referral pathways to facilitate CBTi access. These barriers are compounded in rural and remote general practice settings, where access to mental health clinicians trained in CBTi is limited.
The Research and Evaluation Study of digital Treatment of insomnia in Underserved Populations (REST UP) study aims to study the effectiveness of three digital-assisted insomnia management pathways in rural and remote Australian general practice:
- Self-guided Bedtime Window
- GP-guided Bedtime Window (including three GP consultations)
- Digital sleep health education with delayed access to Bedtime Window
GPs and patients are reimbursed for trial activities, and GPs can claim CPD hours for involvement.
Bedtime Window is an interactive five-session digital insomnia management program that has been tested in
randomised controlled trials in Australian general practice and community settings. It has been co-designed with patients and GPs for integration into our health system.
Several thousand GPs and patients have engaged with Bedtime Window, which is associated with moderate-to-large and sustained improvements in
sleep,
daytime function, and
mental health, and
reduced sedative-hypnotic use.
Dr Bianca Cannon is co-chief investigator of the REST UP study, who says as a GP, it is an ‘accessible, standardised and evidence-based program’ to refer patients with chronic insomnia to.
‘I have already referred patients to Bedtime Window as a self-guided digital program and we know this to be highly effective from previous studies,’ Dr Cannon said. ‘However in this trial, we are also allocating some patients and practices to a clinician-guided group whereby patients will receive additional support and guidance from their GP as they complete the program, hopefully allowing for the extra benefits of blended care and continuity of care.’
The REST UP team have received both GP and patient testimonials demonstrating the benefits of the program so far, particularly from those in rural and remote areas where there is limited options for face-to-face provision of CBTi.
GPs in rural and remote settings (Monash Modified Model 2+) can contact
Associate Professor Stijn Soenen to participate in the REST UP project.
GPs in metropolitan settings can contact
Bedtime Window staff to refer patients to other primary care research studies.
Professor Zwar is chief investigator of the REST UP study. This study is approved by the Bond University Human Research Ethics Committee.
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benzodiazepines CBTi insomnia mental health care rural general practice sleep health
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