Everyone has difficulty sleeping at some point in their life but in most cases this is short term. However, around one in ten people suffer chronic insomnia, which occurs on a regular basis or over a long period of time. It is most commonly caused by stress and worry but can also be triggered by pain, noise, medication, depression and shift-work. Insomnia is associated with psychological, physical and social problems, contributing to daytime tiredness, which can lead to accidents, work or relationship problems.

This project aims to improve treatment for people with insomnia by promoting a range of treatment options beyond sleeping pills, which are not always the most appropriate course of action and carry the risk of side effects and addiction.

“We’ve surveyed about 1,000 patients and 40 practices in Lincolnshire, focusing on patients who had had a repeat prescription of sleeping tablets in the previous six months,” project lead Professor Niroshan Siriwardena of the University of Lincoln and NHS Lincolnshire explains. “Nine out of ten patients were on a repeat prescription that had been started by their GP. About two thirds hypnotics every night, which is not a good thing to do because of addiction, and half had side effects like headache, dizziness and nausea. One fifth of the patients wanted to stop their tablets and at least half of the patients said they’d tried to come off treatment.”

“We also surveyed GPs, who had beliefs about drug treatments that tended to promote prescribing of newer, more expensive sleeping tablets contrary to the evidence that these are no more effective,” he continues. “But they also had some good ideas on how to improve the situation.”

The project is trying to discourage GPs from prescribing sleeping pills inappropriately or as a first line response, and to encourage them to explore other treatment options first, which may be more in line with what patients actually need. “We also want to find ways of helping people who have been on sleeping pills for some time but would prefer not to be,” Niro adds.

“It’s a bit analogous to the position with antibiotics,” Niro continues. “In the late 1970s and early 1980s, it was very common for people to be prescribed an antibiotic for a sore throat or earache. When research was done into this, they found that GPs felt much more pressure to prescribe than patients actually wanted. So you got a mismatch, and that led to very high prescription rates. Nowadays, we don’t prescribe so many antibiotics for sore throats and upper respiratory infections.”

Some of the alternative treatments available include sleep hygiene and sleep restriction. “Sleep hygiene is really a bundle of things which aim to regulate sleep patterns,” Niro says. “It includes avoiding things like caffeine, alcohol, exercise and eating late in the evening. Sleep restriction means initially going to sleep later to ensure good quality sleep, making sure you wake up at the same time every day, which is better for your body clock, and then gradually moving back your time to go to sleep.”

I think that the REST project is a tremendous initiative. For years, sleep has been a rather neglected topic in the NHS. The REST project provides practical, evidence based help, and I would encourage GPs to make full use of it.

Professor Colin Espie

Since joining REST we have significantly changed our approach – we have reduced hypnotic prescribing by using alternative strategies including sleep diaries and simple CBTi techniques.

Dr Zubair Qureshi