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Prevalence and treatment of insomnia in general practice

A longitudinal study

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European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript


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.

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  • American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders. 3rd edn. Revised. APA, Washington DC

    Google Scholar 

  • Angst J, Vollrath M, Koch R, Dobler-Mikola A (1989) The Zurich Study. VII. Insomnia: Symptoms. Classification and Prevalence. Eur Arch Psychiatr Neurol Sci 238:285–293

    Article  Google Scholar 

  • Bixler EO, Kales A, Soldatos CR, Kales JD, Healy S (1979) Prevalence of Sleep Disorders in the Los Angeles Metropolitan Area. Am J Psychiatry 136:1257–1262

    PubMed  Google Scholar 

  • Consensus Conference (1984) Drugs and Insomnia. The Use of Medications to Promote Sleep. JAMA 2410–2414

  • Everitt DE, Avorn J, Baker MW (1990) Clinical Decision-Making in the Evaluation and Treatment of Insomnia. Am J Med 89: 357–362

    Article  PubMed  Google Scholar 

  • Ford DE, Douglas B, Kamerow DB (1989) Epidemiologic Study of Sleep Disturbances and Psychiatric Disorders. An Opportunity for Prevention? JAMA 262:1479–1484

    Article  PubMed  Google Scholar 

  • Geiselmann B, Linden M (1991) Prescription and Intake Patterns in Long-Term and Ultra-Long-Term Benzodiazepine Treatment in Primary Care Practice. Pharmacopsychiatry 24:55–61

    PubMed  Google Scholar 

  • Hohagen F, Schönbrunn E, Berger M (in press) Benzodiazepin-Hypnotika: Indikationen, Dosierung, praktische Durchführung, allgemeine Behandlungsrichtlinien. In: Laux G, Riederer P (eds) Psychopharmaka

  • Kales A, Soldatos CR, Bixler EO, Kales JD (1983) Rebound insomnia and rebound anxiety: a review. Pharmacoly 26:121–137

    Google 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 239–244

  • 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, 37–60

    Google Scholar 

  • Kupfer DJ, Frank E, Perel JM (1989) The Advantage of Early Treatment Intervention in Recurrent Depression. Arch Gen Psychiatry 46:771–775

    PubMed  Google Scholar 

  • Liljenberg B, Almquist M, Hetta J, Roos BE, Agren H (1988) The Prevalence of Insomnia: The Importance of Operationally Defined Criteria. Ann Clin Res 20:393–398

    PubMed  Google 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, 1–12

    Google Scholar 

  • Mellinger GD, Balter MB, Uhlenhuth EH (1985) Insomnia and its Treatment. Arch Gen Psychiatry 42:225–232

    PubMed  Google 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 134:460–466

    Google 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, 121–123

    Google Scholar 

  • Vollrath M, Wicki W, Anst J (1989) The Zurich Study. VIII. Insomnia: Association with Depression, Anxiety, Somatic Syndromes, and Course of Insomnia. Eur Arch Psychiatr Neurol Sci 239:113–124

    Article  Google 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, 73–85

    Google Scholar 

  • Weyerer S, Dilling H (1991) Prevalence and Treatment of Insomnia in the Community: Results from the Upper Bavarian Field Study. Sleep 14:392–398

    PubMed  Google Scholar 

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Hohagen, F., Rink, K., Käppler, C. et al. Prevalence and treatment of insomnia in general practice. Eur Arch Psychiatry Clin Nuerosci 242, 329–336 (1993).

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