The aim of the study was to assess prevalence and treatment modalities of
insomnia in general practice. To investigate the course of
insomnia, a longitudinal study design was adopted. Two thousand five hundred and twelve patients (age 18-65 years) were investigated with a questionnaire in general practice (T1). Four months later (T2) and again 2 years later (T3) a questionnaire was sent to all patients who had complained about severe
insomnia at the time of the first inquiry. To assess
insomnia, operationalized diagnostic criteria were applied (DSM-III-R). Eighteen point seven percent suffered from severe, 12.2% suffered from moderate and 15% suffered from mild
insomnia. In the course of 2 years
insomnia appeared as a chronic health problem. A high comorbidity of severe
insomnia was found with chronic somatic and
psychiatric disorders, especially with depression. Of the severely insomniac patients, 23.9% used prescribed
hypnotics habitually, mainly
benzodiazepines. The use of prescribed
hypnotics remained rather stable during the whole study period. More than half of the patients reported a daily use of the
hypnotics for 1-5 years or longer, but only 22% of the severely insomniac patients reported at the time of the third inquiry a significant improvement of
insomnia due to the administration of
sleeping pills. Thus, the long-term administration of
benzodiazepine hypnotics seems to be an inadequate treatment strategy in
chronic insomnia. Whether the occurrence of
rebound insomnia after
benzodiazepine withdrawal may be one of the main factors for chronic
hypnotic use requires discussion.(ABSTRACT TRUNCATED AT 250 WORDS)