Benzodiazepines and non-benzodiazepines use for primary insomnia in Saudi Arabia

PhD Researcher, Ali Dhobia, presenting the findings of his project at the School of Pharmacy Research & Scholarship Seminar

Background: Despite the increasing use of benzodiazepines (BZDs) and Z-drugs for insomnia, there are no KSA guidelines or data on prescribing patterns.

Aim: To explore prescribing practices for treating insomnia in the Kingdom of Saudi Arabia (KSA) and to begin the development of national guidelines.

Method: A mixed methods design was used in three phases. I: A retrospective audit of patients prescribed BZDs or Z-drugs for insomnia (April 2012 to March 2017) in King Fahad Central Hospital in Jazan, KSA.Audit criteria were based on two US guidelines. Descriptive statistics, using STATA, were used to report findings. II: A qualitative study of physicians’ knowledge, perceptions and attitudes about treating primary insomnia and using US guidelines. Thematic analysis, using NVivo, was applied. III: Guideline development used an e-Delphi technique. We recruited 17 insomnia experts who participated in developing consensus (≥ 80% agreement) around future national guidelines.

Results: Phase I: Of 504 records retrieved over five years, 379 patients (75%) were prescribed BZDs or Z-drugs; only 182 (48%) had documented use. Of 307 patients (60%) diagnosed with insomnia, none received cognitive behaviour therapy for insomnia (CBT-I). No patients were reviewed by physicians for long-term use. No records met all criteria. Phase II: Perceptions and attitudes of physicians in KSA toward using US or other international guidelines were based on knowledge, resistance and the presence of barriers and facilitators. Phase III: Sixteen statements fulfilled the criteria to be included in future KSA guidelines.

Conclusion: The Ministry of Health should enhance public awareness about insomnia, provide training, improve administration, and encourage documentation. The consensus guidelines developed will standardize the use of BZDs and Z-drugs in the treatment of primary insomnia among Saudi adults. With these guidelines evidence will be translated into best practice by practitioners in Saudi Arabia.