The RACGP benzodiazepine guideline supports the use of BBTi, which can be delivered by general practitioners (GPs) and practice nurses with minimal training and without the need for costly overnight sleep studies. 13,14 BBTi distils the most essential and effective behavioural components of CBTi into a succinct four-session program.
To encourage the adoption of CBTi techniques in primary healthcare settings, a ‘brief behavioural therapy for insomnia’ (BBTi) has been developed.
INSOMNIA TEST FULL
Furthermore, a lack of suitably trained healthcare providers in Australia who are capable of administering full CBTi programs has resulted in a greater need for effective evidence-based management of insomnia that can be provided in general practice. 7,11 CBTi has historically been delivered by trained psychologists or therapists over a course of six to eight individualised 30–50 minute sessions, but this is impractical for the Australian general practice setting. 10 Hence, cognitive and behavioural strategies to manage insomnia are preferable to sedative–hypnotic medications, which are associated with only short-term improvements and pose potential risk of medication dependence, tolerance and serious adverse events. 8 Because CBTi targets the underlying psychological, behavioural and physiological process and factors that underpin and perpetuate the disorder, 7,9 improvements resulting from CBTi are sustained far beyond the cessation of therapy. 7 The core treatment components of CBTi include stimulus control therapy, bedtime restriction therapy, relaxation training, cognitive therapy and educational information about sleep. The Royal Australian College of General Practitioners (RACGP) guideline Prescribing drugs of dependence in general practice, Part B – Benzodiazepines recommends cognitive behavioural therapy for insomnia (CBTi) as the first-line treatment. 5,6 Chronic insomnia is a costly and debilitating disorder, which requires targeted diagnostic and treatment approaches. 2–4 Insomnia results in significant economic costs to Australia through lost work productivity, increased healthcare utilisation, reduced quality of life, and increases risk of future depressive and anxiety disorders. 1 Chronic insomnia occurs in approximately 6–12% of the general population and commonly persists for many years unless targeted non-pharmacological treatments are provided. Chronic insomnia is characterised by difficulties initiating sleep, maintaining sleep, and/or early morning awakenings from sleep, with associated daytime impairments, persisting for at least three months.
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