HOW TO TREAT 33
M Tu W Th F Sa Su
Martin
C
C
C
12:30 am 6:00 am
0 min 0 min 30 min 0 min 30 min 60 min 0 min
120 min
Figure 7 . Sleep diary completed before session three . Because Martin ’ s average SOL and WASO were both less than 30 minutes during the previous week , his TIB can be extended by 30 minutes for the next week .
C C C
30 min 0 min 0 min 30 min 0 min 0 min 0 min
60 min
9 min 17 min
5 h 5.5 h 5 h 5.5 h 5.5 h 4.5 h 5.5 h
36.5 h
5.2 h
5.5 h 5.5 h 5.5 h 5.5 h 5.5 h 5.5 h 5.5 h
38.5 h
5.5 h
Symptomatology ( QIDS ) bit . ly / 3FkNR0N
• PHQ-9 bit . ly / 30usURC
• Access to CBTi — This Way Up ( online ) CBTi for managing insomnia bit . ly / 3Cb8Vox
— SA Health insomnia management kit bit . ly / 3wLMghf
— Re-Time Australia : How to Sleep Better eBook bit . ly / 3wNyZVm
— Adelaide Institute for Sleep Health ( Flinders University ) step-by-step guide for Australian GPs to administer a brief CBTi program during GP appointments bit . ly / 3HtNSBd
— MBS Online mental health treatment plan ( Better Access initiative ) to refer patients with insomnia to a psychologist for CBTi bit . ly / 3kBtsN2
— MBS Online specialist psychological services via telehealth bit . ly / 3xh8doM
reassures him that feelings of sleepiness in the evening are normal and that this will help him to fall asleep when he does go to bed .
Martin scores 25 / 32 on the sleep condition indicator .
After several weeks of bedtime restriction therapy , Martin now understands how to use the 30 – 30 rule to continue gradually adjusting his time in bed to manage his
1 . Which THREE statements regarding chronic insomnia are true ? a Insomnia often co-occurs with other mental and physical health problems . b Around 10-15 % of Australian adults fulfil the diagnostic criteria for chronic insomnia disorder . c Evidence-based guidelines recommend sedative – hypnotics as first-line treatment for insomnia . d Sedative – hypnotic medications are one of the most common treatments for insomnia .
2 . Which ONE daytime symptom is NOT commonly associated with insomnia ? a Fatigue and malaise . b Decreased appetite . c Poor mood and irritability . d Concentration , memory and attention difficulties .
3 . Which THREE form part of the ‘ 3P model ’ for describing insomnia ? a Predisposing factors . b Prolonging factors . c Precipitating factors . d Perpetuating factors .
4 . Which THREE factors can sleep and wake duration , daytime / evening sleepiness and symptoms of insomnia .
CONCLUSION
INSOMNIA is a highly prevalent and debilitating disorder commonly managed by Australian GPs . When insomnia co-occurs with other sleep , mental and / or physical health problems , it should be conceptualised as
How to Treat Quiz .
perpetuate insomnia symptoms ? a Setting an alarm to get up at a regular time each morning . b Spending too much time in bed , in the hopes of acquiring more sleep , resulting in more time spent awake in bed . c Drinking a lot of coffee throughout the day to help stay awake and alert . d Taking long naps in the afternoon to catch up on lost sleep the night before .
5 . Which THREE statements regarding insomnia and comorbid conditions are correct ? a When insomnia and depression co-occur , the insomnia is generally a secondary symptom of depression . b Insomnia commonly co-occurs with depression . c CBTi is effective for insomnia comorbid with moderate and severe depression . d Antidepressants and antipsychotics are not a comorbid condition that requires targeted assessment and treatment . The most effective treatment for insomnia is non-drug CBTi , which targets the underlying causes of the disorder . CBTi is effective in the presence of comorbid conditions and results in sustained improvement in sleep , and mental health .
There are several options for GPs to access CBTi for their patients ,
GO ONLINE TO COMPLETE THE QUIZ ausdoc . com . au / howtotreat
recommended for the management of insomnia .
6 . Which ONE screening tool assesses for insomnia ? a Epworth Sleepiness Scale . b PHQ-9 . c Sleep Condition Indicator . d OSA50 .
7 . In which THREE areas does CBTi for insomnia provide the greatest improvements ? a Physical health . b Sleep . c Mental health . d Daytime function
8 . Which TWO statements regarding the CBTi are correct ? a Stimulus control therapy helps patient reduce early morning awakenings . b Bedtime restriction therapy aims to reduce time spent awake in bed . c Sleep hygiene is an adequate standalone treatment for insomnia .
EARN CPD OR PDP POINTS
• Read this article and take the quiz via ausdoc . com . au / howtotreat
• Each article has been allocated 2 RACGP CPD points and 1 ACRRM point .
• RACGP points are uploaded every six weeks and ACRRM points quarterly . including referral to an online CBTi program , brief CBTi administered during weekly / fortnightly general practice appointments or referral to a sleep psychologist ( with a mental health treatment plan ).
RESOURCES
• Sleep condition indicator bit . ly / 3FenOIu
• Quick Inventory of Depressive
CHRONIC INSOMNIA
d CBTi aims to identify , test and challenge the maladaptive beliefs that perpetuate insomnia .
9 . Which THREE statements regarding medications in insomnia are correct ? a Benzodiazepines and z-drugs are associated with short-term improvements in sleep . b Longer-term use of benzodiazepines and z-drugs can lead to dependence and negative side effects . c Sedative – hypnotics may be used for four weeks in patients without access to or who are not responding to CBTi . d Medication is never indicated in the management of insomnia .
10 . Which TWO statement regarding CBTi and sedative – hypnotic medication are correct ? a Sudden cessation of a sedative – hypnotic is acceptable once CBTi starts . b Provide support to patient on sedative – hypnotics to gradually withdraw from these medications . c CBTi is not effective in patients taking sedative – hypnotics . d CBTi facilitates medication withdrawal .
Declaration of interest Dr Alexander Sweetman , Professor Doug McEvoy and Professor Leon Lack report receiving funding support from the NHMRC , as well as research equipment and funding support from competitive research grants from ResMed , and Philips Respironics . Dr Sweetman reports research funding from the Flinders Foundation . Professor McEvoy reports equipment support from Air Liquide . Professor Lack reports funding and equipment support and holds shares in Re-Time , Australia Pty Ltd .
The Adelaide Institute for Sleep Health ( Flinders University ) is currently engaged in a program of research to improve GP access to evidence-based tools and treatment options for insomnia and sleep apnoea . GPs interested in gaining experience with these tools in a research context are invited to contact Dr Sweetman ( alexander . sweetman @ flinders . edu . au ).
References available on request from howtotreat @ adg . com . au
2021 / 22 YEARBOOK
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