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Confusion over depression-related sleep problems

A new survey has highlighted "real confusion" in primary care over the appropriate management of patients with sleep disturbances who suffer depression.

A survey of UK GPs has shown that while 90% recognise depression-associated sleep problems as a common and distressing symptom that should be managed in primary care, most (72%) fail to adopt more than a "watch and wait" strategy to managing patients with such symptoms.

The results, from the second phase of the NAtional Patient Sleep Assessment Questionnaire in depression (NAPSAQ-II), reveal that although GPs understand the significance of sleep disturbances and admit they cause patients to visit them more frequently, almost half (42%) said they find such symptoms difficult to treat.

In a separate national survey, sleep disturbances were reported by 97% of people with depression, and are associated with an increased risk of depressive relapse and recurrence.

In addition to adopting a "watch and wait" approach to patients with sleep disturbances, other management strategies GPs claimed to use included promoting good sleep hygiene, prescribing an add-on hypnotic treatment and switching antidepressant medication.

Findings from a previous patient survey showed that of the 69% of patients taking an antidepressant, more than half said it had no effect or worsened their sleep.

Results from NAPSAQ-II suggest that GPs may also question the benefit that current antidepressants have on sleep disturbances. The survey showed that just 21% switch their patient's medication in an attempt to alleviate symptoms.

Commenting on the study, Professor David Nutt, NAPSAQ investigator from the University of Bristol, commented: "This survey highlights a real confusion about the most appropriate management strategies for this widely recognised issue.

"If we are to improve the long-term outcome of patients with depression we not only need to support GPs with clearer recommendations on managing sleep disturbances but also ensure that these are reviewed as new therapeutic options become available."

Servier UK

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Should more be done to address the link between sleep problems and depression? Your comments: (Terms and conditions apply)

"Both categories, 'sleep problems' and 'depression' are far too vague to be targeted adequately. I am a sleep specialist and have seen many instances where insomnia and depressive moods appeared very much to be a chicken-and-egg situation. Antidepressants (USA) have never been approved as sleep-aids. Some SSRIs list insomnia under their side-effects - and are still being prescribed. This issue needs much clarification, and GPs are right to be careful when medicating for a condition that common sense suggests might well be a symptom of an unwholesome lifestyle. There are useful new resources: Gayle Greene's disparaging book Insomniac; and then a very different approach - Siegfried Haug's I Want to Sleep - Unlearning Insomnia. He focuses on the transition from a 'wired mind' to a 'tired body'. A person at odds who needs to learn to soothe themselves rather than have yet another battle (against insomnia)". - Jane, Massachusetts, USA