Sufficient and good-quality sleep is essential for health and wellbeing. In prevalence studies, nearly half (48%) of all Australian adults report at least two sleep-related problems, such as inadequate sleep or sleep disorders.¹ Sleep-related problems can be due to a number of predisposing, precipitating and perpetuating factors² and conditions, such as obstructive sleep apnoea (OSA) or insomnia. OSA and insomnia can co-exist. Sleep-related problems are also associated with an increased risk of type 2 diabetes, cardiovascular disease, coronary heart disease, anxiety, depression and stroke.^1,3,4 GPs can advise patients on the importance of practising good sleep hygiene.

Obstructive sleep apnoea

OSA is among the most common sleep disorders found in the general population worldwide.¹ The prevalence of undiagnosed OSA is high,¹⁰ and it is associated with considerable morbidity.

The symptoms of OSA are varied, but can include^2,5:

• excessive daytime sleepiness, fatigue or falling asleep during the day, despite length of sleep
• snoring (which may be loud or irregular)
• choking or gasping during sleep
• witnessed breathing cessation
• sleep disruption and frequent awakenings
• nocturia
• difficulty with concentration, memory and other executive functions
• depressed mood
• decreased work performance.

Untreated OSA can have significant impacts, including:^3,11

• cardiovascular morbidity and mortality (including hypertension, coronary artery disease, stroke, atrial fibrillation, congestive heart failure)
• increased risk of motor vehicle accidents
• increased risk of occupational accidents
• cognitive impairment
• diabetes
• lost work days
• decreased quality of life
• mortality.

Some of the common risk factors for OSA include:^1,2

• male sex
• age >50 years
• modifiable risk factors such as smoking, overweight and obesity and alcohol use
• postmenopause (women).

There is currently insufficient evidence to screen the asymptomatic general population for OSA. Instead, initial assessment for symptomatic patients should encompass patient history, questionnaires and physical examination.

Insomnia

Insomnia causes problems falling or staying asleep, and can be categorised as acute (less than three months in duration) or chronic (more than three months duration). There are several predisposing, precipitating and perpetuating factors that may contribute to the development of insomnia disorder.² Insomnia can greatly impact a person’s quality of life and overall health.

Acute insomnia generally occurs due to a psychological or physiological stressor, and typically resolves once the stressor has been removed or the patient has adapted to the stressor.² It is important to reassure the patient that acute insomnia does not develop into chronic insomnia most of the time, and to manage the stressor that is causing the sleep difficulties.²

Women experiencing menopause and perimenopause may experience insomnia.¹²

Chronic insomnia is present for at least three nights per week for three or more months, occurs despite adequate opportunity for sleep and causes significant distress or impairment in daytime functioning.²

The assessment of insomnia disorder is based on patient-reported sleep history and questionnaires.

Please see the Resources tab for more information on behavioural therapies for insomnia.

The new topic of Sleep will be included in the new edition of the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people, released mid-2024.

The prevalence of OSA is increased in patients:²

• with type 2 diabetes
• with hypertension and cardiovascular disease
• prescribed sedative medications.

Case finding for OSA may be beneficial in commercial vehicle drivers and pilots.²

In addition to factors that may increase the risk of insomnia, a report to the Sleep Health Foundation found several factors associated with the highest prevalence rates of insomnia in the Australian population,¹³ including:

• lower income
• financial stress
• unemployment
• retirement
• being unable to work due to disability.

The Sleep Primary Care Resources include a comprehensive list of risk factors that contribute to the development of:

• obstructive sleep apnoea
• insomnia disorder.

Evidence-based resources and information to assess and manage adult patients with OSA and insomnia:
Sleep Health Primary Care Resources | Australasian Sleep Association

Non-drug behavioural interventions for patients experiencing insomnia and sleep problems:
Cognitive behavioural therapy for chronic insomnia in Handbook of non-drug interventions (HANDI) | RACGP
Brief behavioural therapy: Insomnia in adults in Handbook of non-drug interventions (HANDI) | RACGP
Behavioural intervention: Infant sleep problems and maternal mood in Handbook of non-drug interventions (HANDI) | RACGP

Guidance on sleep hygiene, stimulus control, sleep restriction therapy, relaxation and cognitive therapies:
GP guide to behavioural therapy for insomnia | RACGP

Evidence-based guidance on the use of benzodiazepines:
Prescribing drugs of dependence in general practice, Part B: Benzodiazepines | RACGP