Improving the management of Insomnia in Community General Adult Mental Health Care
J. G. HeslopIntroduction
Sleep disturbance is a prevalent issue, affecting approximately 78% of individuals with mental health disorders. Evidence-based treatments such as cognitive behavioural therapy for insomnia (CBT-i), sleep hygiene practices, and hypnotic medications are known to be effective. This quality improvement project aimed to assess current clinical practice and enhance the management of insomnia in community general adult psychiatric care, aligning with national guidelines (Donaldson et al., BJMP 2009; NICE CKS, 2025).
Objectives
The primary aim was to improve the recognition and management of insomnia. A secondary aim was to develop and implement educational and procedural interventions that promote adherence to national guidance. A closed-loop audit cycle was used to evaluate the prevalence of insomnia and assess the impact of targeted interventions on clinical practice.
Methods
An initial audit cycle reviewed clinical records from 48 randomly selected patients seen over the previous five months. Data were collected on the identification and management of insomnia, namely the use of sleep hygiene advice, CBT-i techniques, and hypnotic prescribing. A multidisciplinary focus group informed an education programme which was delivered to the clinical team, covering sleep physiology, national treatment guidelines, and practical CBT-i principles (e.g. sleep restriction and cognitive restructuring). A simplified sleep management algorithm was developed and distributed (see image 2). Following these interventions, a second audit cycle was completed.
Results
1) Insomnia prevalence was 58% and 63& in audit cycle 1 and 2 respectively (see all data in Table 1).
2) Sleep hygiene advice was given to 36% and 45% of relevant patients in audit cycle 1 and 2 respectively.
3) CBT-i strategies were used in 11% of cases in audit cycle 1, and increased to 27% in audit cycle 2.
4)
Hypnotic prescribing remained limited. Zopiclone and promethazine were the most used. Combination hypnotic use was observed in 15% and 8% of patients in audit cycle 1 and 2 respectively.
Image 1: Long description.