Resources for Effective Sleep Treatment REST

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The project worked to discourage GPs from prescribing sleeping pills as a first line response, and to encourage them to explore other treatment options first, which may be more in line with what patients actually need.

There is evidence that sleep assessment tools and psychological treatments, such as cognitive behavioural therapy, are under-used. Sleeping pills are often prescribed inappropriately and for too long with consequent side-effects.

Alternative treatments available include sleep restriction and a sleep hygiene approach which includes avoiding things like caffeine, alcohol, exercise and eating late in the evening.

The project team analysed prescribing data, surveys and focus groups to understand the problem of sleep management and used a range of methods to improve it.

The project used a multidisciplinary approach involving patients, clinicians, practices and pharmacy support. It worked with patients to understand what they need from a consultation for insomnia and tested the impact of different approaches.

The project tested collaborative learning as a quality improvement model in primary care with eight practices over a six month period.

Benefits

The team demonstrated innovative ways to respond to the management of insomnia using non-drug alternatives and showed how they could be 'normalised' in primary care.

Participating practices reported evidence of change in clinical routines, benefits to patients’ experiences of care, and significant reductions in prescribing in some practices.

The team received further funding to spread the learning through e-learning and other educational initiatives, and a grant from the Engineering and Physical Sciences Research Council to develop innovative ways of providing computerised cognitive behaviour therapy to insomnia sufferers in future.

Who was involved?

Partners included: East Midlands Mental Health Research Network Hub, Lincolnshire and Nottinghamshire Mental Health Trusts, Lincoln and Nottingham Universities, Trent Research and Development Support Unit.

Since this project was completed...

Findings, which included improvements in patients’ experiences of care, and significant reductions in prescribing sleeping pills in some practices, went on to be shared at a UK-wide event in 2011 run by the Royal Society of Medicine. Later that year, the findings were broadcast in an ITV documentary. Since then, the success of REST has led to national changes in health service policy and practice, with findings incorporated in guidance to clinicians developed by the National Prescribing Centre.

REST has also made a considerable international impact (its findings even being cited by the North American Space Agency (NASA) through a series of workshops, seminars and e-learning resources, resulting in changed behaviour among GPs, nurses and practice teams, and changed relationships with patients. Clinicians have moved away from prescribing drugs to using psychological therapies for insomnia – a cultural shift towards shared care and greater patient involvement.