Insomnia: Doctors need more training

Charlotte Mackey, senior healthcare analyst at Datamonitor, said: "Key opinion leaders interviewed by Datamonitor expressed a strong belief that despite the high prevalence of insomnia, improvement in recognition, diagnosis and treatment is required. In particular, recommend improved physician training in relation to insomnia is recommended.

"The key issue is that a sizeable proportion of patients do not seek medical advice about sleeping problems, with the majority either ignoring the problem or using self-help methods such as alcohol, natural remedies or over-the-counter (OTC) products".

Insomnia is not a trivial concern

For example, a UK-based study of primary insomnia patient found that for 56%, the most commonly cited reason for not seeking treatment was the perception of insomnia as benign, trivial or a problem than one should be able to cope with alone.1 Similarly, according to the National Sleep Foundation's 2005 'Sleep in America' poll, some 45% of responders reported that they would talk to a doctor if they thought they had a sleep problem, while 18% said they would assume the problem would go away or that they would do nothing about it 1.

"Physician-related factors also pose important barriers to the recognition and treatment of insomnia" Mackey says. "Physicians may avoid discussing problems such as sleep difficulties due to the time constraints of GP office visits and the perception that treatment of insomnia centres upon pharmacological substances that are associated with risks. Moreover, key opinion leaders maintain that the limited time dedicated to sleep medicine in medical training leads to diagnostic and treatment hurdles in insomnia."

How it's diagnosed

Insomnia is defined as a subjective perception of dissatisfaction with the amount and/or quality of sleep and may include symptoms of: difficulty initiating sleep, difficulty maintaining sleep, difficulty returning to sleep after waking too early and non-restorative or poor quality sleep. Insomnia also involves daytime consequences such as fatigue, lack of energy, difficulty concentrating and irritability.

Environmental, psychological, lifestyle and physical factors as well as medication side-effects can contribute to insomnia, either independently or in combination. A diagnosis of insomnia is usually made through obtaining a sleep history, which provides the physician with information relating to the nature, severity and duration of the patient's sleep problem.

The UK prescription drug market for insomnia was worth £47 million (about R540 million) in 2009, a value which Datamonitor projects to grow to £58 million (about R670 million) by 2019, driven by uptake of treatments currently in development.