Summary:
Flinders University researchers are calling for Australia to shift from reliance on sleeping pills to cognitive behavioral therapy for insomnia (CBT-I), the recommended first-line treatment for the condition. Despite its proven effectiveness, only 1% of Australians with insomnia access CBT-I, prompting researchers to propose six key recommendations to improve education, training, and availability of the therapy. The study emphasizes the need for systemic change, citing structural barriers and lack of awareness as major obstacles to widespread adoption of this non-drug treatment.
Key Takeaways:
- Low Access to CBT-I: Only 1% of Australians with insomnia access CBT-I, despite evidence showing it to be the most effective long-term treatment for the condition.
- Six Key Recommendations: Researchers outlined six steps to increase access, including training programs for GPs and psychologists, online management guidelines, and digital CBT-I tools.
- Call for Systemic Change: The study highlights structural barriers, such as limited funding and awareness, as contributors to Australia’s overreliance on sleeping pills, urging a shift toward evidence-based behavioral therapies.
Instead of reaching for a pill, more people should switch to the recommended first-line therapy for insomnia: the non-drug option.
Cognitive behavioral therapy for insomnia (CBT-I) has been rated the most effective long-term solution for the common sleep condition, and Flinders University experts are calling for more general practitioners (GPs) and psychologists to help roll it out in Australia.
While non-drug insomnia treatment is becoming more accessible for patients having trouble sleeping, it is still only accessed by 1% of people with insomnia, says Flinders University research fellow Alexander Sweetman, PhD.
“Sleep problems are among the most common reasons that patients present to their doctor in Australia,” Sweetman says in a release. “Sleeping pills are still the mainstay management option for insomnia, despite a lot of evidence suggesting that behavioral treatments are much more effective in the long-term. CBT-I is the most effective and recommended first-line treatment for insomnia because it treats the underlying causes of long-term insomnia without drugs, and hundreds of scientific studies have demonstrated its effectiveness.
Sweetman continues, “Improved access to this non-drug behavioral treatment in the Australian health system will relieve the difficulties faced by people with this common debilitating sleep disorder.”
Insomnia’s Impact on Health and Society
The prevalence of chronic insomnia is about 10-15% in Australian adults at any given time. Short-term insomnia is more common but can be related to many different causes and not always treated with CBT-I.
Untreated insomnia is associated with an increased risk of psychiatric conditions, hypertension, accidents, and sick leave and incurs high economic and societal costs through reduced quality of life, productivity, and increased use of healthcare resources.
The researchers from Flinders University and the Sax Institute have published a five-year study in the Journal of Clinical Sleep Medicine calling for more Australian health professionals to promote CBT-I.
GPs at the Center of the Push for Change
“GPs play a central role in Australia’s universal health care system,” says coauthor Doug McEvoy, MD, Flinders University emeritus professor, in a release. “They are often the first point of contact with patients engaging with the health system, screen and deliver care for many health conditions, and operate as ‘gatekeepers’ for referral to specialist medical services. As a result, GPs were at the center of our insomnia translation program to improve access to CBT-I.
“We are urging more GPs and psychologists to access CBT-I training resources and offer evidence-based CBT-I to people with insomnia symptoms—rather than drugs.”
The research includes ongoing collaborations with the SAX Institute, Australasian Sleep Association, Sleep Health Foundation, Australian Psychological Society, Royal Australian College of General Practitioners, and other groups.
Six Recommendations to Expand CBT-I Access
With this diverse group of stakeholders, the study resulted in six major recommendations:
- Improve GP awareness of insomnia and CBT-I
- Raise awareness among GPs and psychologists of funding options to access CBT-I
- Develop GP education resources, including an online primary care insomnia management guideline
- Establish a psychologist CBT-I training program in collaboration with the Australian Psychological Society and Australasian Sleep Association
- Launch a GP CBT-I training program at Flinders University Sleep Health in collaboration with the Royal Australian College of General Practitioners and the General Practice Mental Health Standards Collaboration.
- Develop and test an interactive digital CBT-I program.
Optimism for Change in Australia’s Insomnia Care
“Most GPs interviewed were aware of the risks of long-term use of sleeping pills but had very little knowledge of CBT-I and how their patients could access it,” says sleep expert Jenny Haycock, PhD, whose doctoral studies at Flinders University were part of the five-year study, in a release. “There seems to be a readiness for change, so I am optimistic that many more insomnia patients will be able to access this best-practice care with increased awareness of CBT-I amongst GPs and their patients.”
Senior Flinders University respiratory and sleep physician Robert Adams, MD, says new education and training opportunities will help to turn the tide.
“We encourage patients and their partners to ask their GPs about CBT-I and join the Sleep Health Foundation and the Australasian Sleep Association in advocating to the Government for ways to improve Australians’ access to non-drug interventions,” says Adams, who also worked on the latest article, in a release.
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