PDF(Pubmed)
Abstract：
BACKGROUND: It is unclear how primary care physicians manage insomnia after the introduction of novel hypnotics such as orexin receptor antagonists and melatonin receptor agonists. This Web-based questionnaire survey aimed to examine treatment strategies for insomnia in Japanese primary care practice.
METHODS: One-hundred-and-seventeen primary care physicians were surveyed on the familiarity of each management option for insomnia on a binary response scale (0 = \"unfamiliar\"; 1 = \"familiar\") and how they managed insomnia using a nine-point Likert scale (1 = \"I never prescribe/perform it\"; 9 = \"I often prescribe/perform it\"). Physicians who were unfamiliar with a management option were deemed to have never prescribed or performed it.
RESULTS: Regarding medication, most physicians were familiar with novel hypnotics. Suvorexant was the most used hypnotic, followed by lemborexant and ramelteon. These novel hypnotics averaged 4.8-5.4 points and 4.0-4.7 points for sleep onset and sleep maintenance insomnia, respectively. By contrast, most benzodiazepines were seldom used below two points. Regarding psychotherapy, only approximately 40% of the physicians were familiar with cognitive behavioral therapy for insomnia (CBT-I) and they rarely implemented it, at an average of 1.5-1.6 points. More physicians were familiar with single-component psychotherapies (i.e., relaxation, sleep restriction therapy, and stimulus control) compared to CBT-I, and 48-74% of them implemented it slightly more often, with scores ranging from 2.6 to 3.4 points.
CONCLUSIONS: This study suggests that Japanese primary care physicians seldom use CBT-I to treat insomnia. In addition, they use novel sleep medications more frequently than benzodiazepines in terms of pharmacotherapy. The use and availability of CBT-I in Japanese primary care might be facilitated by: educating primary care physicians, implementing brief or digital CBT-I, and/or developing collaborations between primary care physicians and CBT-I specialists.
METHODS: One-hundred-and-seventeen primary care physicians were surveyed on the familiarity of each management option for insomnia on a binary response scale (0 = \"unfamiliar\"; 1 = \"familiar\") and how they managed insomnia using a nine-point Likert scale (1 = \"I never prescribe/perform it\"; 9 = \"I often prescribe/perform it\"). Physicians who were unfamiliar with a management option were deemed to have never prescribed or performed it.
RESULTS: Regarding medication, most physicians were familiar with novel hypnotics. Suvorexant was the most used hypnotic, followed by lemborexant and ramelteon. These novel hypnotics averaged 4.8-5.4 points and 4.0-4.7 points for sleep onset and sleep maintenance insomnia, respectively. By contrast, most benzodiazepines were seldom used below two points. Regarding psychotherapy, only approximately 40% of the physicians were familiar with cognitive behavioral therapy for insomnia (CBT-I) and they rarely implemented it, at an average of 1.5-1.6 points. More physicians were familiar with single-component psychotherapies (i.e., relaxation, sleep restriction therapy, and stimulus control) compared to CBT-I, and 48-74% of them implemented it slightly more often, with scores ranging from 2.6 to 3.4 points.
CONCLUSIONS: This study suggests that Japanese primary care physicians seldom use CBT-I to treat insomnia. In addition, they use novel sleep medications more frequently than benzodiazepines in terms of pharmacotherapy. The use and availability of CBT-I in Japanese primary care might be facilitated by: educating primary care physicians, implementing brief or digital CBT-I, and/or developing collaborations between primary care physicians and CBT-I specialists.
摘要：
背景：目前尚不清楚初级保健医生在引入新型催眠药如食欲素受体拮抗剂和褪黑素受体激动剂后如何治疗失眠。这项基于网络的问卷调查旨在研究日本初级保健实践中失眠的治疗策略。
方法：以二元反应量表（0=\“不熟悉\”；1=\“熟悉\”）调查了一百一十七位初级保健医生对每种失眠管理方案的熟悉程度，以及他们如何使用九分利克特量表（1=“我从不开/执行它\”；9=“我经常开/执行它\”）。不熟悉管理选项的医生被认为从未开过处方或执行过。
结果：关于药物，大多数医生都熟悉新的催眠药。苏沃雷生是最常用的催眠药,其次是lemborexant和Ramelteon.这些新型催眠药对睡眠发作和睡眠维持失眠的平均分为4.8-5.4分和4.0-4.7分，分别。相比之下,大多数苯二氮卓类药物很少在两点以下使用。关于心理治疗，只有大约40%的医生熟悉失眠症认知行为疗法(CBT-I)，他们很少实施。平均1.5-1.6点。更多的医生熟悉单组分心理治疗(即，放松,睡眠限制治疗,和刺激控制)与CBT-I相比，48-74%的人更频繁地实施它，分数在2.6到3.4分之间。
结论：这项研究表明，日本初级保健医生很少使用CBT-I治疗失眠。此外,在药物治疗方面，他们使用新型睡眠药物比苯二氮卓类药物更频繁。CBT-I在日本初级保健中的使用和可用性可能会通过以下方式得到促进：教育初级保健医生，实施简短或数字CBT-I，和/或发展初级保健医生和CBT-I专家之间的合作。
方法：以二元反应量表（0=\“不熟悉\”；1=\“熟悉\”）调查了一百一十七位初级保健医生对每种失眠管理方案的熟悉程度，以及他们如何使用九分利克特量表（1=“我从不开/执行它\”；9=“我经常开/执行它\”）。不熟悉管理选项的医生被认为从未开过处方或执行过。
结果：关于药物，大多数医生都熟悉新的催眠药。苏沃雷生是最常用的催眠药,其次是lemborexant和Ramelteon.这些新型催眠药对睡眠发作和睡眠维持失眠的平均分为4.8-5.4分和4.0-4.7分，分别。相比之下,大多数苯二氮卓类药物很少在两点以下使用。关于心理治疗，只有大约40%的医生熟悉失眠症认知行为疗法(CBT-I)，他们很少实施。平均1.5-1.6点。更多的医生熟悉单组分心理治疗(即，放松,睡眠限制治疗,和刺激控制)与CBT-I相比，48-74%的人更频繁地实施它，分数在2.6到3.4分之间。
结论：这项研究表明，日本初级保健医生很少使用CBT-I治疗失眠。此外,在药物治疗方面，他们使用新型睡眠药物比苯二氮卓类药物更频繁。CBT-I在日本初级保健中的使用和可用性可能会通过以下方式得到促进：教育初级保健医生，实施简短或数字CBT-I，和/或发展初级保健医生和CBT-I专家之间的合作。
