Abstract
Purpose
Sleep disturbance is common in primary care. The main treatment options include medication
and cognitive behavioral therapy for insomnia. Best practice guidelines recommend
a collaborative decision-making approach to treatment. This study examined differences
in insomnia treatment preferences based on demographic and clinical characteristics
among primary care patients.
Methods
A total of 200 patients (mean [SD] age, 54.92 [12.48] years) at a university medical
center and community health clinic participated in brief screenings for insomnia,
depression, anxiety, and insomnia treatment preference. Insomnia symptoms were measured
with the Insomnia Severity Index, whereas depressive and anxiety symptoms were measured
with the Patient Health Questionnaire 2 and Generalized Anxiety Disorder 2. χ2 analyses were performed to detect significant differences in preference between groups.
Findings
A total of 46.5% of participants preferred medication and 56.0% preferred behavioral
treatment (ratings not exclusionary). Preference for behavioral treatment was highest
among severe insomnia presentations (15.2% preferred to 4.5% disliked; P = 0.002). Medication preference was higher among patients with elevated anxiety (57.3% preferred to 42.7% disliked; P = 0.017). Preference for behavioral treatment (66.7% preferred to 33.3% disliked;
P = 0.012) and medication (56.8% preferred to 43.2% disliked; P = 0.016) was highest among those with elevated depression. Treatment preference only
differed by age for behavioral treatment (P = 0.008). Preference was highest among patients ≤51 years of age (67.2% preferred
to 32.8% disliked).
Implications
Primary care patients preferred behavioral and medication strategies for insomnia
treatment. In addition, as mental health and sleep worsen, patients were more likely
to prefer behavioral treatment. Knowledge of patient treatment preference may facilitate
shared decision making, which increases patient satisfaction with care and engagement
with treatment.
Keywords
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Article info
Publication history
Published online: March 28, 2022
Accepted:
March 2,
2022
Identification
Copyright
© 2022 Elsevier Inc.
