Insomniacs 'should be given therapy not sleeping pills'

NHS told to roll out cognitive behavioural treatment after success of research projects

Nina Lakhani
Friday 17 August 2012 23:18

Tens of thousands of insomniacs could be helped to sleep better every year if NHS staff were trained to provide safe psychological therapies, according to a leading specialist in the field.

One in four Britons suffers from poor sleep and one in 10 has a sleep disorder, but the vast majority suffer in silence or turn to potentially harmful drug treatments.

Sleep problems can exist in isolation, but are more common in people with mental health problems and chronic physical conditions such as heart disease, dementia and Parkinson's disease.

Cognitive behavioural therapy (CBT), which is increasingly used to treat people with depression and anxiety, is also clinically proven to help insomniacs to sleep better.

But while CBT has been rolled out across England to treat those with mental health problems by training 3,500 practitioners based in GP surgeries, it is rarely available to insomniacs. Kevin Morgan, a professor of gerontology at the University of Loughborough, has been researching the condition for the past 20 years.

He says at least £3m of taxpayers' money has been spent on research into CBT and insomnia, with little to show for it in access to treatment. Instead, tens of millions of pounds are spent on over-the-counter and prescription sleeping tablets, which work only in the short term, can lead to addictions and cause accidents and falls.

Last year, more than 12 million prescriptions for sleeping tablets were dispensed across England, Scotland and Wales. "The evidence is undisputable, we have a workforce and we have training programmes that work, yet access to treatment for patients is very patchy. Insomnia has never really been on the Department of Health's radar and there is no central drive to improve access," Professor Morgan told The Independent.

Current practitioners need training in order to correctly adapt the CBT for insomnia. This includes understanding the two processes that can be manipulated to improve a person's sleep: learnt behaviours such as spending too long in bed awake trying to get to sleep, and the over-thinking that goes on before sleep.

Professor Morgan and his team have trained some health workers in the East Midlands and Oxfordshire, but with no national guidelines, the roll-out has been patchy. "It is not the ideal health service response to a chronic disabling problem; it needs central coordination," he said.

The latest research examined the effectiveness of self-help CBT for 55 insomniacs with long-term physical health problems.

Patients were sent booklets explaining how sleep works and how to gain control over it, and were provided with telephone support.

"Subjectively, people reported better sleep, a decrease in insomnia symptoms and in some cases less reliance on medication. It is still better to see a therapist but in their absence, the self-help training programme is an effective alternative," he said.

The research, funded by the Economic and Social Research Council, will be published in the Journal of the American Geriatrics Society later this year.

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