Sleep problems - Insomnia Management Kit

The information contained in this web page is a general guide written for health professionals. If you are having sleeping problems, it is important to seek advice from a qualified professional.

Insomnia Management Kit

The Insomnia Management Kit is designed for GP's with patients who report sleep problems.

It will assist GP's in the assessment, diagnosis and management of patients presenting for the first time with a sleep problem.

The kit is comprised of fact sheets that can be downloaded below.

The kit contains:

• How to use this Kit, Instructions for GPs (PDF 135KB)
• Three assessment tools
  1. Epworth Sleepiness Scale (in Sleep Assessment (PDF 155KB) fact sheet)
  2. Assessment Flow Chart and Symptoms/Management Table (in Sleep Assessment fact sheet (PDF 155KB)
  3. Sleep Diary (in Sleep Diary fact sheet (PDF 222KB))
• A Sleep Medication fact sheet (PDF 128KB)
• Five management fact sheets:
  1. Sleep: Facts and Hygiene (PDF 233KB)
  2. Stimulus Control Therapy  (PDF 123KB)
  3. Bedtime Restriction Therapy (PDF 130KB)
  4. Bright Light Therapy (PDF 125KB)
  5. Relaxation Therapy (PDF 129KB)

Assessment tools

These assessment tools may be incorporated into the patient's file once completed.

1. Epworth Sleepiness Scale (in Sleep Assessment fact sheet (PDF 155KB)). Determines any impact on daytime sleepiness.
2. Assessment Flow Chart & Symptoms / Management Table (in Sleep Assessment fact sheet (PDF 155KB)). Identifies the possible cause/s of the sleep difficulty and makes management recommendations.
3. Sleep Diary (in Sleep Diary fact sheet (PDF 222KB)). Provides a more comprehensive assessment of the sleep pattern over a week.

Instructions are provided with each assessment tool.

Approximate time required to complete tools are:

• Epworth Sleepiness Scale (3 to 5 minutes)
• Assessment Flow Chart and Symptoms/Management Table (5 to 10 minutes)
• Sleep Diary (2 minutes per day over 7 days).

Sleep Medication fact sheet

The Sleep Medication fact sheet (PDF 125KB) is recommended for:

• patients requesting repeat prescriptions of sleep medications for sleep difficulties
• patients presenting for the first time with a sleep difficulty to discourage the commencement of sleep medication
• patients provided with 'short-term' sleep medication prescriptions, to discourage continued use of sleep medication.

Management tools

After completing the sleep assessment and sleep diary, one or more of the management techniques will be recommended for the patient.

Management techniques

• Sleep: Facts and Hygiene (PDF 233KB)
• Stimulus Control Therapy (PDF 123KB)
• Bedtime Restriction Therapy (PDF 130KB)
• Bright Light Therapy (PDF 125KB)
• Relaxation Therapy (PDF 129KB).

There are also several other management techniques which are best accessed through a clinical psychologist.

• Cognitive Behavioural Therapy with or without Relaxation Therapy.
• Multicomponent Therapy with Cognitive Therapy
  (includes a combination of stimulus control therapy, sleep restriction and sleep hygiene education).
• Paradoxical Intention
  (Aim: eliminate performance anxiety, instructing patient to remain passively awake and avoid any effort to fall asleep).
• Biofeedback – Cognitive Behavioural Therapy
  (involves providing visual and auditory feedback to patients to help control some physiological parameters to reduce somatic arousal).

Professor Leon C. Lack and Dr Helen Wright, School of Psychology, Flinders University assisted with the information in these resources.

How to use this kit

Option 1 (for a single consultation)

• Complete the Epworth Sleepiness Scale (PDF 155KB) with the patient.
• Complete the Assessment Flow Chart (PDF 155KB) with the patient.
• Provide the recommended management fact sheet(s).

Option 2 (preferred, for two consultations)

• Guide the patient through the Epworth Sleepiness Scale (PDF 155KB) to determine any effect on daytime sleepiness.
• Provide the patient with the Sleep Diary (PDF 222KB) to complete at home and arrange a follow-up appointment in a weeks time.
• At follow-up: Analyse the Sleep Diary, complete the Assessment Flow Chart (PDF 155KB) and provide the recommended management fact sheet(s).

Note: If the patient has previously used sleep medication, discourage continued use and provide the Sleep Medication fact sheet (PDF 128KB).

Further information or advice

Alcohol and Drug Information Service (ADIS)

ADIS is a telephone information, counselling and referral service.

Phone: 1300 13 1340

8.30am to 10pm every day.

Drug and Alcohol Clinical Advisory Service (DACAS)

DACAS provides a telephone and email service for South Australian health professionals seeking clinical information and clarification around clinical procedures, guidelines and evidence-based practice.

Telephone: (08) 7087 1742 — 24 hours 7 days/week including public holidays or e-mail your enquiry to:  HealthDACASEnquiries@sa.gov.au.

This service does not provide proxy medical cover and cannot assume responsibility for direct patient care.