3 February 2010

The latest NPS education program Management options to maximise sleep encourages prescribers to recommend non-drug therapies as first-line treatment for insomnia and to discuss the importance of good sleep practices and the potential harms of hypnotic medicines with the patient before prescribing hypnotics.

BEACH data from 2006-08 shows medication was prescribed for 95.2 per 100 insomnia problems*, however research from the Agency for Healthcare Research and Quality in the US has shown non-drug therapies have comparable effectiveness to hypnotic medicines.

“Insomnia is often a secondary health issue caused by identifiable stressors, a medical or psychiatric condition, poor sleep practice and medicine or substance use,” NPS senior clinical adviser, Judith Mackson said.

“As well as addressing insomnia, identifying and addressing the cause may eliminate the need for hypnotics. For many people rectifying poor sleep practices will make a huge difference to the quality of their sleep.”

As well as comparable effectiveness, non-drug therapies do not carry the same potential adverse effects or dependency risks as hypnotics.

The ‘Management options to maximise sleep’ program encourages health professionals to:

• Explore patient concerns with sleep difficulties – identify and address causes
• Offer behavioural and cognitive therapies for insomnia
• Discuss and specify the duration of hypnotic medicines use
• Trial discontinuing hypnotic medicines in patients who have been using them for long periods
• Engage patient/carers in managing sleep difficulties

“There is particularly high use of hypnotic medicine in the elderly, yet this group is more at risk of adverse events. For patients who have been taking hypnotics for a prolonged time, prescribers are encouraged to develop plans to decrease their dose and review progress through the GP clinical audit tool provided by NPS as part of this program,” Ms Mackson said.

In cases where drug treatment cannot be avoided, as non-drug therapies alone are not effective, patients should be prescribed the lowest effective dose for the shortest duration and educated on the adverse effects of hypnotic medicines. Initial prescriptions should be limited to less than ten days.

The NPS has developed the following resources and activities about managing insomnia for health professionals:

• NPS News (67): Addressing hypnotic medicines use in primary care
• Prescribing Practice Review (49): Management options for improving sleep
• GP and GP Registrar Clinical Audit - Use of benzodiazepines, zolpidem and zopiclone in insomnia
• Case study (62): Maximising sleep and minimising potential harms
• Drug Use Evaluation (DUE) tool: Benzodiazepine and non-benzodiazepine hypnotic medicines for insomnia in aged care facilities
• One-on-one educational visiting by NPS facilitators
• Small group discussions led by NPS facilitators

For further information visit www.nps.org.au/health_professionals.

*Source: Charles J, Harrison C, Britt H. Australian Family Physician 2009;38:283

ENDS

The National Prescribing Service Limited (NPS) is an independent, not-for-profit organisation for quality use of medicines funded by the Australian Government Department of Health and Ageing.