‘De-Pharmaceuticalizing' Sleep? Patient and Professional Perspective on Presciption Hypnotics in UK Primary Care

In this paper we look at UK General Practitioners’ (GPs’) views of prescribing hypnotics in primary care and compare and contrast these with patient perspectives and experiences, in the context of debates about the (de)pharmaceuticalisation of sleep. Data are qualitative in nature, drawn from focus groups with chronic users of sleeping pills and semi-structured interviews with GPs.

We examine the degree to which the views of patients with respect to both aetiology of their sleep problem and prescription of pharmaceuticals converge or diverge with medical discourses on these matters. We discuss the role of so-called lay ‘expertise’ in the therapeutic management of sleep problems, the perceived value of pharmaceuticals, and the importance of building mutual trust between GPs and patients in the medical encounter.

We argue that in practice, medical views on the value of hypnotics, beliefs about ‘deserving’ and ‘undeserving’ patients and corresponding prescribing practices have permeable borders which regularly break down the partitions between these categories, turning GPs into reluctant prescribers of sleeping pills. In the doctor’s view, the recognition of lay expertise is thought to enrich medical encounters, give patients a voice of their own and increased responsibility for their healthcare practices. From the patients’ perspective, enacting the identity of ‘informed patient’ is not straightforward or easily accomplished. In this study the boundary between medical expert and patient was still fairly robust. The patient perspective emphasizes a split between lay and expert views on the value of pharmaceuticals versus non-pharmacological therapies in the management of sleep problems, as well as in the assessment of risk of becoming addicted to sleeping pills.  Our paper therefore contributes to recent work on the (de) pharmaceuticalisation of society, the changing nature of the doctor –patient relationship in the digital age and lay experiences of chronic illness.