TY - JOUR T1 - Non-pharmacological management of chronic insomnia in primary care JF - British Journal of General Practice JO - Br J Gen Pract SP - 79 LP - 80 DO - 10.3399/bjgp08X264018 VL - 58 IS - 547 AU - Brian McKinstry AU - Philip Wilson AU - Colin Espie Y1 - 2008/02/01 UR - http://bjgp.org/content/58/547/79.abstract N2 - One-fifth of patients consulting in primary care have insomnia1 and prevalence in the population ranges from 10–12% to over 20% in older adults.2 It is the most common symptom of mental illness, regardless of age, sex, or ethnic group.3 Insomnia is more common than worry, and twice as common as anxiety or depressive symptoms. Typically, insomnia is associated with reduced daytime alertness and productivity, poorer quality of life, impaired relationships, and increased ill health.4 It is the largest, potentially treatable, risk factor for depression5 and is a major cause of accidents.6Persistent insomnia presents a challenge for most GPs. The problem is often unrecognised and management is generally unsatisfactory.7 Many doctors manage the condition with ‘off-label’ prescribing of hypnotic or sedative antidepressant drugs, neither of which have demonstrated more than marginal efficacy.8 There is little evidence that the new generation of hypnotics has improved the management of persistent insomnia.9 Adverse effects of hypnotics are common10 and an investigation of drug-associated hospital admissions among older patients has shown that up to 10% may be due to benzodiazepines.11 Despite the fact that many would prefer a non-pharmaceutical approach if an effective one were available, hypnotics are nevertheless often requested by patients and withdrawal often poses difficulties for doctors and patients as a … ER -