Abstract

Background
Insomnia affects around one-third of adults in the UK.
Many sufferers seek help from primary care.
Aim
To explore patients’ and primary care practitioners’
expectations, experiences, and outcomes of consultations for sleep difficulties, as a basis for
improving the treatment of insomnia in primary care.
Design of study
A qualitative phenomenological approach.
Method
Separate focus groups for GPs and nurse prescribers
and patients recruited from eight general practices that
were in a quality improvement collaborative. Constant
comparative analysis was used.
Results
Emergent themes from 14 focus groups comparing
participating patients (n = 30) and practitioners (n = 15),
provided insights on presentation, beliefs, expectations,
and management of sleep problems. Patients initially
tried to resolve insomnia themselves; consulting was
often a last resort. Patients felt they needed to convince
practitioners that their sleep difficulties were serious.
They described insomnia in terms of the impact it was
having on their life, whereas clinicians tended to focus
on underlying causes. By the time patients consulted,
many expected a prescription. Clinicians often assumed
this was what patients wanted, and felt this would
hamper patients’ ability to take non-drug treatments
seriously. Clinicians expected patients who were already
on sleeping tablets to be resistant to stopping them,
whereas patients were often open to alternatives.
Conclusion
Better management of insomnia should take into
account the perceptions and interactions of patients
and practitioners. Practitioners need to empathise,
listen, elicit patients’ beliefs and expectations, assess
sleep better, and offer a range of treatments, including
cognitive and behavioural therapies, tailored to
individual needs. Practitioner education should
incorporate understanding of patients’ decision-making
processes, the clinicians’ role during the consultation,
and how to negotiate and deliver strategies for
resolving sleep problems.