Prevalence and treatment of insomnia in general practice
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The aim of the study was to assess prevalence and treatment modalities of insomnia in general practice. To investigate the course of insomnia, a longitudinal study design was adopted. Two thousand five hundred and twelve patients (age 18–65 years) were investigated with a questionnaire in general practice (T1). Four months later (T2) and again 2 years later (T3) a questionnaire was sent to all patients who had complained about severe insomnia at the time of the first inquiry. To assess insomnia, operationalized diagnostic criteria were applied (DSM-III-R). Eighteen point seven percent suffered from severe, 12.2% suffered from moderate and 15% suffered from mild insomnia. In the course of 2 years insomnia appeared as a chronic health problem. A high comorbidity of severe insomnia was found with chronic somatic and psychiatric disorders, especially with depression. Of the severely insomniac patients, 23.9% used prescribed hypnotics habitually, mainly benzodiazepines. The use of prescribed hypnotics remained rather stable during the whole study period. More than half of the patients reported a daily use of the hypnotics for 1–5 years or longer, but only 22% of the severely insomniac patients reported at the time of the third inquiry a significant improvement of insomnia due to the administration of sleeping pills. Thus, the long-term administration of benzodiazepine hypnotics seems to be an inadequate treatment strategy in chronic insomnia. Whether the occurrence of rebound insomnia after benzodiazepine withdrawal may be one of the main factors for chronic hypnotic use requires discussion. Although insomnia may be an important symptom of many somatic and psychiatric disorders, the general practitioner was unaware in more than half of the cases that the patients suffered from a sleep problem. Severe insomniac patients displayed a higher mean number of medical consultations compared with good sleepers or patients with mild insomnia, indicating that insomnia constitutes a significant burden for the primary care physicians.
Key wordsInsomnia General practice Benzodiazepine prescribing
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- American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders. 3rd edn. Revised. APA, Washington DCGoogle Scholar
- Consensus Conference (1984) Drugs and Insomnia. The Use of Medications to Promote Sleep. JAMA 2410–2414Google Scholar
- Hohagen F, Schönbrunn E, Berger M (in press) Benzodiazepin-Hypnotika: Indikationen, Dosierung, praktische Durchführung, allgemeine Behandlungsrichtlinien. In: Laux G, Riederer P (eds) PsychopharmakaGoogle Scholar
- Kales A, Soldatos CR, Bixler EO, Kales JD (1983) Rebound insomnia and rebound anxiety: a review. Pharmacoly 26:121–137Google Scholar
- Karacan I, Thornby JI, Anch M, Holzer CE, Warheit GJ, Schwab JJ, Williams RL (1976) Prevalence of sleep disturbance in a primarily urban Florida County. Soc Sci Med 239–244Google Scholar
- Karacan I, Thornby JL, Williams RL (1983) Sleep Disturbance: A Community Survey. Sleep/Wake Disorders: Natural History, Epidemiology, and Long-Term Evolution. Guilleminault C, Lugaresi E (eds) Raven Press, New York, 37–60Google Scholar
- Lugaresi E, Cirignotta F, Zucconi M, Mondini S, Lenzi PL, Coccagna G (1983) Good and poor sleepers: an epidemiological survey of the San Marino population. In: Guilleminault C, Lugaresi E (eds). Sleep/wake disorders: natural history, epidemiology, and long-term evolution. Raven Press, New York, 1–12Google Scholar
- Rüther E et al. (1992) Epidemiologie, Pathophysiologie, Diagnostik und Therapie von Schlafstörungen. Ergebnisse einer Consensus-Konferenz der Arbeitsgemeinschaft Klinischer Schlafzentren (AKS) und der Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP). Muench Med Wochenschr 134:460–466Google Scholar
- Strauch I, Dubral I, Struchholz C (1973) Sleep behaviour in adolescents in relation to personality variables. In: Jovanovic UJ (ed) The nature of sleep. International Symposium. Würzburg 1971. Fischer, Stuttgart, 121–123Google Scholar
- Welstein L, Dement WC, Redington D, Guilleminault C, Mitler MM (1983) Insomnia in the San Francisco Bay Area: A Telephone Survey. Sleep/Wake Disorders: Natural History, Epidemiology, and Long-Term Evolution. Guilleminault C, Lugaresi E (eds) Raven Press, New York, 73–85Google Scholar