Management of Insomnia Complaints by Non-Sleep Specialist Physicians: A French DELPHI Consensus.

Abstract

Insomnia is the most prevalent sleep disorder and a major public health concern, affecting chronically up to 19% of the adult population in France. Despite its significant impact on quality of life, mental health, and cardiometabolic disease, insomnia disorder remains underdiagnosed and inadequately managed. General Practitioners (GPs) play a pivotal role in addressing insomnia complaints but often face constraints, such as limited consultation time and a lack of specialised training. To provide practical recommendations for non-sleep specialist physicians, a French Delphi consensus was conducted based on recent expert guidelines. A multidisciplinary Steering Committee formulated 21 clinical statements regarding the evaluation, severity assessment, management, and referral to sleep specialists of patients presenting with insomnia disorder. These statements were submitted to a panel of 37 GPs across France via two rounds of anonymous rating using a 9-point Likert scale. While a consensus was reached for 95% of the statements, encompassing initial evaluation, sleep hygiene recommendations, behavioural interventions, and referral criteria, controversies emerged regarding the prescription of hypnotics, underscoring areas requiring further clarification and education. Our results highlight the importance of tailored approaches in primary care, emphasising pragmatic strategies rather than highly specialised protocols. This French Delphi consensus provides a structured yet flexible framework to support insomnia disorder management by non-sleep specialist physicians, bridging the gap between guidelines and real-world clinical practice.