Letters to the Editor
The Reality of Healthcare Provision
The authors deserve many thanks for their up to date and insightful treatise (1). I was very pleased to see that as regards the treatment of insomnia, mention was made of the fact that cognitive behavior therapy for insomnia (CBT-I) is often scarcely available. Most other articles, textbooks, and recommendations (associations of statutory health insurance physicians, the medical periodical Arznei-Telegramm, etc) on this topic only criticize drug treatment and mention the very good data in support of CBT-I. The actual health service reality is, however, vastly different.
In our practice we pay a lot of attention to insomnia and sleep related disorders, and we try to avoid drug treatment as far as possible. In spite of this it was not possible for us over the past five years to make behavioral therapy available to even only one patient with statutory health insurance. This means that even in the Rhine-Main region, the services provided are de facto nowhere near sufficient.
In a conversation with several psychotherapists it was communicated to us that the effort is not worth it and is not attractive within the range of healthcare services on offer. In this setting, the introduction of digital health applications that reflect CBT-I has closed a gap, at least for some of those affected. Still, this is not a principle that can be applied to all.
On the background of the high prevalence of primary insomnia and the associated economic costs (inability to work, secondary diseases, accidents, etc), awareness/perception of it and especially its treatment should be supported to a far greater degree. Articles such as the present one (1) can therefore contribute to moving the subject into the focus of attention.
DOI: 10.3238/arztebl.m2024.0027
Dr. med. Patrik Finkenwirth
Internist, Darmstadt
finkenwirth@praxis-finkenwirth.de
Conflict of interest statement
The author declares that no conflict of interest exists.
| 1. | Freund W, Weber F: The function of sleep and the treatment of primary insomnia. Dtsch Arztebl Int 2023; 120: 863–70 VOLLTEXT VOLLTEXT |
