This week is mental health awareness week and the Mental Health Foundation are marking the occasion with an awareness raising campaign about sleep.
Their Sleep Matters report from January of this year calls for improved access to psychological therapies for people who suffer from insomnia. It highlights that in the UK you are more likely to be prescribed medication for a sleep disorder than given a psychological therapy, despite the fact that there is more evidence for CBT.
Here is the conclusion from their full report:
Poor sleep and insomnia are not always treated in accordance with the best current knowledge. In clinical practice, medication is more commonly prescribed for insomnia than CBT, although CBT is more effective in the long term. CBT is sometimes seen as difficult to access due to its relatively high cost and because of the lack of trained therapists available.
The IAPT programme may have the potential to address some of this need, if staff members are sufficiently trained to recognise and work with sleep problems. Current NICE guidance on the treatment of insomnia mentions the importance of psychological approaches, but the benefits of such approaches have not yet been expanded upon sufficiently.
The amount of evidence for CBT in the treatment of insomnia makes it difficult to ignore. It would appear that fitting such therapies into clinical practice relies upon employing a stepped care approach. Only the most severe cases of chronic insomnia need to be treated by a specialist sleep practitioner.
The majority of people who are suffering poor sleep might benefit from simple, non-intrusive methods such as a guided self-help book or course delivered over the internet. These kinds of interventions should be based upon the principles of CBT, but would be far more efficient in terms of health spending. There is already some evidence in favour of using simple, self-guided therapies to treat sleep problems.
If a person with poor sleep finds such therapies to be ineffective, then primary care workers such as nurses or GPs should be able to give evidence- based guidance on how to improve sleep. Beyond this, graduate psychologists may be able to offer short CBT courses in an individual or group setting, and clinical psychologists might review more complex cases where there is an underlying mental health problem to be treated. There are several stages that can be tried before enlisting the help of a specialist sleep practitioner.
Poor sleep is a public health problem and needs to be taken seriously. It needs to be recognised within healthcare, education, and society at large. For society, it is vitally important that sleep is seen as a public health issue, much like diet and exercise. Sleep needs to be an issue on any public health agenda. If this does not happen, a great number of people will suffer the consequences, without reason.
People with suspected sleep disorder can take the Great British Sleep Survey to find out the extent of their condition.
Mental Health Awareness Week page. Mental Health Foundation.
Sleep Matters: the impact of sleep on health and wellbeing (PDF). Mental Health Foundation, Jan 2011.
www.Sleepio.com Sleep expert Professor Colin Espie’s website and blog, which features the Great British Sleep Survey; an online tool that can help diagnose sleep problems.
Insomnia – newer hypnotic drugs (TA77). NICE, Apr 2004.