Introduction Insomnia has increasing prevalence. Most insomnia management occurs within primary care; NICE advise secondary care referral if primary care treatment fails or for high-risk occupations.1Cognitive behavioural therapy for insomnia (CBTi) is the recommended first-line treatment for chronic insomnia, but widespread CBTi is limited by number of specialty-trained clinicians and resource. Brief behavioural therapy for insomnia (BBTi) is effective in treating patients with acute and chronic insomnia.2–4 Extensive private insomnia services exist, indicating demand for insomnia treatments. Prohibitive costs exclude many of our local population, contributing to health inequalities. Local management options include digital CBTi or referral to a partner organisation with limited capacity.
Methodology A new insomnia clinic delivering BBTi was established to alleviate expanding waitlists and provide intensive therapy option for patients with insomnia. Clinic design is shown in figure 1.
Discussion Seventy patients have been referred, 37 diagnosed with insomnia and 29 commenced BBTi. The service reduces time to accessing insomnia care (993 days v 136 days) and has improved sleep measurements, for example mean sleep efficiency increased by 31%.
Multiple challenges were encountered requiring continuous service evaluation and improvement. Administration role recruitment problems caused fragmented clinic bookings and diverted clinician time to ensure necessary patient paperwork was completed. Changes to block bookings alleviated many of these challenges but was a more significant loss of resource should a patient cancel their appointments. Evolving accommodations were implemented for patients whom English is a second language, or those who might have difficulty accessing digital care. Refinement of triage process has improved patient engagement.
Conclusions BBTi as an intervention is effective which could address some of the current treatment access issues. Establishing novel services requires sufficient administration resources to enable clinicians to complete effective therapies. Patient screening is crucial to ensure that patients are appropriate for specialist BBTi services.
NICE. Clinical Knowledge Summary: Insomnia. May 2022. Available online: cks.nice.org.uk/topics/insomnia/
Ellis J, Cushing T, Germain A. Treating acute insomnia: a randomised controlled trial of a ‘sing-shot’ of cognitive behavioural therapy for insomnia. Sleep. 2015;38(6):971–978
Buysse D, Germain A, Moul D, et al. Efficacy of brief behavioural treatment for chronic insomnia in older adults. Archives Internal Medicine. 2011;171(10):887–95.
Bramoweth A, Lederer L, Youk A, et al. Brief behavioural treatment for insomnia vs. cognitive behavioural therapy for insomnia: results of a randomised noninferiority clinical trial among veterans. Behavioural therapies. 2020;51(4):535–547.
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