General Practitioner and Practice Nurse perceptions of sleep, sleep problems and insomnia: a qualitative study

Abstract

Insomnia is common, can have a negative impact on quality of life and is associated with risks to health. The majority of people seeking medical help for insomnia are seen in primary care. However, research suggests awareness of insomnia (sleep problems) in primary care is low and treatment options are inadequate, indicating that sleep and sleep problems are not considered a priority. In order to understand these issues this study aims to explore how primary care professionals perceive sleep, sleep problems and insomnia.

A qualitative design was chosen because this allowed for an exploration of professionals’ perspectives through semi-structured, face-to-face interviews. General practitioners and practice nurses working in Cheshire were recruited by means of written invitation letters. Eight GPs and three practice nurses participated. Interviews were recorded and transcribed verbatim. NVivo software was used to manage the data, which was analyzed using thematic content analysis.

Nine of 61 GPs, and five of 14 practice nurses invited agreed to participate. The findings indicate that GPs, rather than practice nurses, are responsible for managing sleep problems in primary care and that GPs do not like consultations about sleep problems because they feel they have no solution to offer. GPs describe management approaches such as normalizing sleep problems and focusing on underlying causes. Sleep problems were not viewed as harmful or as having direct health consequences or as a priority for funding. Lack of training, lack of acceptable prescription medication and the influence of NHS policy appear to contribute to the low priority given to sleep.

If awareness and management of sleep problems are to be improved GPs need to understand the associated impact and health risks and need to feel they have treatment options to offer. Improved education and training and increased provision of non-drug treatment options is needed.