Prescription of Psychotropic Drugs for Chronic Insomnia in Primary Care

Insomnia is the most prevalent sleep disorder in adults, representing a major public health problem. Healthcare management in a specific area first requires analysing its current practices and issues. We conducted a retrospective observational study of over 100,000 patients from two large primary care databases in the public healthcare Department of Sagunto (Valencia, Spain), from 2009 to 2017. Cases of insomnia were defined by ICD-10 codes, and prescriptions of hypnotics were collected. The data analysis was performed on epidemiological aspects, comorbidity, diagnosis and treatment of insomnia. A significant increase in the incidence of insomnia occurred, rising from 58.9 per 1000 inhabitants (95% CI: 57.7-60.0) in 2009 to 91.4 per 1000 inhabitants (95% CI: 90.0-92.9) in 2017. A total of 12,404 prescriptions for hypnotics and sedatives were issued, including 39.8% for indications other than insomnia. Lorazepam was the most frequently prescribed hypnotic-sedative (36%), followed by zolpidem (21.1%); 54% of insomnia cases revealed more prescription units than medical consultations, suggesting automatic renewals. Excessive prescription of hypnotic drugs for insomnia, along with a lack of follow-up, were identified as significant issues.