Primary care management of chronic insomnia: a qualitative analysis of the attitudes and experiences of Australian general practitioners

Abstract Background Chronic insomnia is a highly prevalent disorder, with ten to thirty percent of Australian adults reporting chronic difficulties falling asleep and/or staying such that it causes significant daytime impairment. Current general practice guidelines recommend cognitive behavioural therapy for (CBTi) as first line treatment insomnia, however research suggests most consultations result in prescription hypnotic or sedative medicines. Although the point contact patients experiencing symptoms often practice, little known about current role, experiences and capacity practitioners manage insomnia. This study aimed address gap by exploring attitudes opinions regarding management, inform development implementation new models best care within practice. Methods A descriptive, pragmatic qualitative study. Purposive sampling was used recruit practising practitioners, varying age, years experience geographic location. Semi-structured interviews were conducted, data analysed using thematic analysis. Results Twenty-eight participated Three major themes identified: 1) Responsibility care; 2) Complexities managing insomnia; 3) Navigating pathways. Whilst readily accepted responsibility management provision demanding difficult funding time constraints Patients presenting comorbid mental health conditions decision-making long-term use benzodiazepines presented challenges practitioners. confidently provided sleep hygiene education patients, their knowledge CBTi, access understanding specialised referral pathways limited. Conclusions General report whilst assessing can be demanding, an integral part Insomnia presents complexities Greater clarity options, targeted effective treatments, specialist services, benzodiazepine withdrawal support psychologists, would benefit