Sleeping Pills Prescribed for Insomnia

Australian National Prescribing Service Help for Sleep and Insomnia

I’ve been digging a bit deeper into the information available on the Australian National Prescribing Service website in relation to sleeping pills and insomnia – and I must say, I’m pretty impressed.

What I’m not impressed with is the apparent lack of conformity between what that NPS site recommends and the results of the BEACH (Bettering the Evaluation and Care of Health) program between April 2006 and March 2008.

Here is the reference to the NPS News 67: Addressing hypnotic medicines use in primary care information: http://www.nps.org.au/health_professionals/publications/nps_news/current/nps_news_67

So What’s The Big Deal about Sleeping Pills being Prescribed for Insomnia?

Here’s the problem:

When we look at NPS News 67 (above) we see the following statements being made:

  • “Most people develop insomnia secondary to an identifiable stressor, medical or psychiatric condition, poor sleep practice, medicine or substance use.”
  • “Non-drug therapies are directed at the physiological, psychological, behavioural and environmental factors that affect sleep.  They have comparable efficacy to benzodiazepines and other related drugs.”
  • “People using the therapies in Box 1 (over 4-8 weeks) fall asleep faster and reduce their time awake after sleep onset by up to 30 minutes more than placebo or no treatment.  Improvements can persist for up to 2 years after therapy.  Hypnotic medicines do not provide this long-term benefit.”  (Note:  Box 1 contains the non-drug strategies of  “Educational, behavioural and cognitive therapies for insomnia.”  They include advice on good sleep practices, cognitive therapy, stimulus control/learned associations, sleep restriction and relaxation techniques.)
  • “Avoid hypnotic medicine use where possible, especially in older people.”
  • “Limit use to the shortest time possible:  ideally, intermittently (e.g. 2-5 times per week) for < 2 weeks.”
  • “Short-term benzodiazepine use (<2 weeks) at recommended therapeutic doses can usually be stopped abruptly without problem.  However, rebound insomnia and other withdrawal symptoms are still possible.”
  • “Discuss a stopping plan for the hypnotic medicine at the time of the initial prescription.”

So now lets look at the results from the BEACH study:

Here are the BEACH program results, readily available on the internet:

Can you see any differences?  Between best practice recommendations and what is ACTUALLY happening in consultations?

Here are some I observe:

The BEACH program results show:

  • For new cases of insomnia being reported 81.7 percent were prescribed medications.
  • Generally 95.2 percent were prescribed medications.
  • The medications prescribed (in order of the most prescribed) were Temazepam, Zolpidem, Oxazepam, Nitrazepam and Diazepam (the numbers adding up to 87.1, not 95.2: 8.1 unexplained?).

Interesting too, that when we compare ‘encounters with patients’ related to insomnia with normal encounter details we find the following:

  • 95.2 per 100 prescribed medications compared with the 54.5 per 100 in the normal encounter
  • lower than average rates of advice/counselling
  • referral rates per 100 insomnia problems were considerably lower than the BEACH average.
  • pathology tests were significantly lower than the BEACH average.

On the good side, it does show that the duration of an encounter is generally longer.  However I can’t see from the statistics exactly why, since there was less advice/counselling.  Hmmm?

What Does That Mean To You?

My take on this is:

  • firstly, you need to get informed before visiting your health care professional(s)
  • secondly, take full responsibility for the strategies and solutions you adopt – because expert opinion and action seems to vary significantly
  • thirdly – I’m pleased to be presenting natural solutions as options for you to trial, experiment with and/or adopt – depending on what works for you.

Look, I know I might sound like a broken record – but you have to get informed whether you like it or not!

Best wishes and good luck

Elizabeth