Help-Seeking Behavior in Insomnia: A Population Survey

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Sleep Med Res. 2025;16(1):51-58

Publication date (electronic) : 2025 March 25

doi : https://doi.org/10.17241/smr.2025.02691

Mahna Ekhlasi, PharmD¹, Zahra Sharif, PharmD, PhD², Sahar Tohidast, PharmD¹, Farzad Peiravian, PharmD, PhD³, Nazila Yousefi, PharmD, PhD^,3

¹School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran

²Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran

³Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Corresponding Author Nazila Yousefi, PharmD, PhD Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran 1996835113, Iran Tel +98-2188200118 Fax +98-2188200118 E-mail n.yousefi@sbmu.ac.ir

Received 2025 January 30; Accepted 2025 March 5.

Abstract

INTRODUCTION

Insomnia is a common sleep disorder that is categorized as the problem with the initiation or maintenance of sleep, or poor-quality sleep [1]. The prevalence of insomnia, either as a condition or a symptom, is estimated to be about 10%–40% [2-4]. A study from Iran reported that the prevalence rate of insomnia in the general population was 59.2% [5]. Chronic insomnia can reduce the quality of life of patients [6], and causes major mental and emotional issues, depression, functional impairment, and job absence and accidents, if left untreated [7,8]. That’s why untreated insomnia might bring a heavy burden to the society [7,8].

Despite the consequences of insomnia, many insomniacs do not seek medical advice from health professionals like physicians, pharmacists, and psychiatrists. They prefer self-medication and self-help strategies, even though effective behavioral and pharmacological treatments are available [9]. People’s help-seeking behaviors related to insomnia have been examined in several studies. Sandberg et al. [10] concluded that when dealing with insomnia, symptoms are mainly ignored, and staying in bed and praying are the most commonly used strategies. Mazandarani et al. [11], concluded that in Iran, the first response to insomnia was usually to simply roll over in bed and try to fall asleep. Consequently, medical treatment was considered only in severe or chronic cases. Improving diet and eating habits, such as taking dairy products and herbal medicines, have been used to alleviate insomnia. In addition, self-medication has been shown to be a common behavior when facing insomnia. Common self-care strategies for insomnia include the use of natural products, prescription medicines, over-the-counter (OTC) medications, drinking, reading, listening to music, acupuncture, and relaxation exercises [12].

Low health literacy, low knowledge, and patients’ misperception of insomnia, as well as the fact that they believe they do not receive optimal treatment from health care providers, may be their most important reasons for choosing self-medication [12,13]. Patients’ perception that insomnia is an insignificant and self-limiting condition or the view that the already available medications are unattractive or ineffective is a testament to their poor knowledge [14]. In general, patients consider professional medical advice as the last option. Physicians and pharmacists are the most frequently consulted group of health care providers [14], so improving relationships between them has been shown to improve the management of insomnia in the community [15]. In addition, people’s behavior in seeking help for insomnia could be influenced by various factors such as people’s age, gender, socioeconomic status, and health status [16]. People’s self-confidence has also been shown to play an important role in help-seeking behaviors [17].

Insomnia is a widespread issue with its own host of health problems and its impact on patients’ quality of life. The enormous direct and indirect medical costs incurred by the health care system emphasize the importance of this study. Since the behavior of Iranians in dealing with insomnia, their knowledge about insomnia, related treatments, and their experiences in communicating with physicians and pharmacists have not been investigated in a single study so far, this study aims to evaluate the help-seeking behavior of people regarding insomnia, taking into account related factors.

METHODS

The aim of this study was to investigate the behavior of the general population in the face of insomnia and to identify the related factors through a descriptive-analytical cross-sectional survey taken in Tehran, Iran, in 2020.

RESULTS

Demographics

The mean age of the participants was 37.02±12.76 years, 63.1% of the participants were female, and 62.3% were married. In terms of employment status, 56.4% were employed, 4.5% were unemployed, 14.7% were students, 18.4% were retired, and 6% were homemakers. Additional demographic data can be found in Table 1.

Table 1.

Demographics

Health Literacy, Health Self-Confidence, Propensity to Self-Medication, and Lifestyle

The participants’ health literacy was assessed using questions about their understanding of the information they had received from physicians, hospitals, pharmacies, and other medical facilities. Results showed that 14.5% and 44% of the participants had low and moderate levels of health literacy, respectively (Table 2).

Table 2.

Health literacy, health self-confidence, tendency to selfmedication, and lifestyle

The participants’ health self-confidence was assessed through questions about their perceptions of their health status, their ability to care for themselves in the event of common illnesses, and their access to medical care. It was found that 74.8% of the participants had high health self-confidence (Table 2).

We investigated the propensity to self-medication by asking questions about self-care, the frequency of re-filling the physicians’ prescriptions, and reliance on friends’ and relatives’ experiences for treatment. According to the results, the propensity to self-medication was high in 60.9% of the participants.

Lifestyle was assessed by the frequency of habits that affect general health, such as diet and exercise, and some indirect questions, such as questions about driving habits. According to the results, 16.3% of the individuals reported a high-risk lifestyle, and 55.3% reported a low and moderate risk lifestyle (Table 2).

Quality of Relationship with Physicians and Pharmacists

The important role of pharmacists in counseling patients on sleep hygiene, proper use of insomnia medications, and recommending OTC medications, as well as people’s easy access to community pharmacies, underscores the measurement of the quality of this relationship. The quality of people’s relationship with pharmacists was assessed by asking questions about knowledge, perceptions, and trust in pharmacists, as well as the role of pharmacists in the insomnia treatment journey. The results showed that the quality of the relationship between participants and pharmacists was weak in 41.1% of cases and moderate in 47.6% of cases. However, regarding the quality of relationship with physicians, results showed that most of the participants had moderate-to-high-quality relationships with physicians (56.6% and 24.7%, respectively).

Help-seeking behavior

In this section, participants were asked about their help-seeking behaviors related to insomnia. The first question asked them about their first choice when faced with insomnia, and then about their second response if the insomnia was not successfully resolved after their first action. They were also asked about their reasons for visiting physicians or pharmacists (it was also mentioned that choosing more than one option was possible). The results were distributed as shown in Fig. 1.

Fig. 1.

Help-seeking pattern in insomnia.

In the early stages of experiencing insomnia, 20.9% of respondents reported that they mostly ignored the condition. Regarding initial coping strategies, 37.2% of participants started some physical exercise or consumed relaxing drinks, whereas 11.5% chose to self-medicate. Among the self-medication methods, herbal remedies, vitamins, dietary supplements, and sedative medicines were the most commonly used. Only 7.5% of the respondents would prefer to go to a pharmacy to visit a pharmacist for insomnia. However, they believe pharmacists can help them more cost-effectively and in less time due to their greater accessibility. Daytime fatigue (43.2%), chronicity of the case (30.2%), and disruption of personal plans and daily activities (26.8%) were the most common reasons for participants to visit physicians or pharmacists (Fig. 1). When asked about seeking professional help, 17% of participants indicated that they would consult a physician if they experienced insomnia.

Finally, the participants were asked about their expectations regarding the time required to overcome insomnia. The majority (44.9%) believed improvement would occur within 2–3 days, while 27.5% expected recovery in less than one week. Additionally, 23.5% anticipated that it would take 1–2 weeks, and only 4.1% estimated that improvement would require about one month.

Factors influencing help-seeking behavior

The results of the chi-square test showed that at a significant p-value of less than 0.05, there was a significant relationship between help-seeking behavior and the presence of psychiatric disorders (0.009), the use of psychiatric medications (0.009), health self-confidence (0.022), health literacy (0.038), and the quality of communication with physicians (0.032) and pharmacists (0.021). However, no significant association was found between help-seeking behavior and other factors.

Cross-tabulation analysis showed that those who did not suffer from psychiatric disorders were more likely to seek help from a physician for insomnia, while those with one were more likely to seek help from a pharmacist and self-medicate. People with lower health self-confidence were more likely to visit physicians or pharmacists. They were also less inclined to view insomnia as an insignificant, self-limiting, natural, and heritable condition. As self-confidence increases, so does the tendency to use relaxing drinks and exercise to control insomnia.

Although improving health literacy is expected to result in wiser healthcare decisions, participants who were more educated about healthcare used less healthcare and self-medicated more often. As expected, the better the relationship with physicians, the more frequent the physician visits. This was also correlated with a lower propensity to self-medication and a lower likelihood of viewing insomnia as an insignificant, self-limiting, natural, and heritable condition. A moderate to good relationship with pharmacists was associated with more physician and pharmacist visits and less self-medication.

DISCUSSION

The purpose of this study was to investigate the help-seeking behavior of people regarding insomnia and the factors associated with it. The results show that most participants had experienced insomnia at least once, and almost one-fifth often or always suffered from it. The prevalence rate was consistent with previous studies [2-4].

Despite the high prevalence and the large burden that insomnia places on health care systems, previous studies show that most patients do not seek treatment [20,31-33]. Factors leading to not seeking treatment for insomnia include perceiving insomnia as insignificant and self-limiting, lack of awareness, and perceiving the ineffectiveness or unattractiveness of available treatment options for insomnia [14]. Previous studies show that help-seeking behavior among insomniacs is related to age (more in the elderly) [20], socioeconomic status (more in middle and high socioeconomic status) [32,33], gender (more in women) [16,33,34], and educational level (more in the higher educated) [35]. Controversially, our results showed no significant association between any of the demographic variables and people’s help-seeking behavior regarding insomnia; however, the presence of psychiatric disorders and the use of psychiatric medications were significantly correlated with people’s help-seeking behavior. The results also showed that the reasons for visiting a physician or pharmacist for insomnia were the severity of perceived symptoms, persistent insomnia, and the individual and social consequences of insomnia. This finding is consistent with the results of previous studies that proved that suffering from chronic diseases [35], severity and chronicity of the cases, presence of psychiatric disorders [14,33], daytime sleepiness [20], functional impairment [35], loss of enthusiasm [20], daytime fatigue, physical and mental distress, and signs of illness [12,36] were associated with help-seeking behaviors. Leger and Poursain [37] concluded in an international survey that most patients would not take action for their insomnia unless it almost always interfered with their daily functioning. Also, in the present study, more than one-third of the participants tried to solve their insomnia problem by exercising or taking relaxing drinks, and almost one-fourth tried to ignore their insomnia problem because they considered it an insignificant heritable disorder, and only less than one-fourth of the patients sought professional medical help. Passarella and Duong [38] also concluded that one of the main problems with insomnia is that patients and physicians usually underestimate the importance of insomnia. However, as a secondary measure, i.e., if insomnia is not resolved after the first measure, about half of the participants reported that they would visit a physician.

The results demonstrate that most patients did not take any medications to treat their insomnia, and if they did, the use of benzodiazepines was higher. It seems that education about nonpharmacological treatment of insomnia such as cognitive behavioral therapy could be a useful measure to improve people’s rational behavior toward insomnia. Xiang et al. [39] also concluded that in the general Chinese population, of only 5.2% of patients who reported insomnia to their physician, one-third were taking benzodiazepines. However, because of the long-term consequences of benzodiazepines, it is best to be cautious about using them for chronic insomnia [40].

In a study, Cheung et al. [36] concluded that people mostly try self-care strategies such as sleep hygiene and herbal remedies for insomnia. Searching the internet and consulting family, friends, and colleagues were their main sources of data collection. In the present study, the tendency to self-medication was moderate and high in most participants. In self-medication, herbal medicines, herbal teas, dietary supplements, and vitamins were most desired by the participants. Barriers to communication with physicians, from the perspective of those with insomnia, include their knowledge and beliefs about the consequences of insomnia, the social impact, and behavioral control of symptoms [18].

Understanding the symptoms of insomnia and being aware of the impact of insomnia on their daily activities motivate people for seeking treatment. According to our results, although two-thirds of the participants had high and moderate knowledge about insomnia, knowledge about treatments and medications for insomnia was low in about half of the participants. Previous studies have found that implementing social strategies to improve knowledge about insomnia and related treatments could be helpful to reduce the prevalence of chronic cases [12,14,32,36].

People with adequate health literacy are more likely to seek help for health problems, but this association is more pronounced for physical than for mental disorders [13]. As explained earlier, despite the high prevalence of insomnia, few people seek help. This problem requires timely intervention to strengthen sleep health literacy and raise awareness [33]. In our study, most participants had high or moderate health literacy, and a significant association was found between health literacy and people’s help-seeking behavior regarding insomnia. The high health literacy group experienced more self-medication and less desire to seek professional medical help than other groups, underscoring the importance of education in society.

People who have a higher sense of self-confidence adapt more easily to life changes and are more likely to act with the greatest potential. Health awareness, self-confidence, and self-esteem are associated with a more sensible diet and better sleep. Previous studies have found a positive correlation between seeking treatment and having a higher sense of self-confidence [17]. In the present study, there was also a significant association between self-confidence in health and the help-seeking behavior regarding insomnia.

Regarding the role of physicians as they relate to sleep disorders, Mazandarani et al. [11] (2017) concluded that many of the participants felt that their general practitioners were not adequately trained to treat insomnia, often ignored insomnia, and were not well aware of referral ways. This in turn can reduce their trust in healthcare professionals because patients think they are more focused on their own financial interests, which in turn lessons their willingness to seek treatment [11]. Morin et al. [12] concluded that physicians were the most frequently consulted group about insomnia. Therefore, communication with physicians and the restoration of trust in them are important to improve help-seeking behavior of people who have experienced insomnia. In this study, although most participants indicated that they had a moderate-to-high quality relationship with their physicians, the majority still felt more comfortable seeking advice about insomnia from other sources. However, the relationship between psychiatrists and their patients was found to be significantly correlated with the behavior of people seeking help for insomnia. This quality relationship may likely have been evident in the participants’ second response to insomnia.

Pharmacists, in addition to their traditional role as dispensers of medication, have a growing involvement with patient care. Therefore the factors that influence this relationship need to be identified in order for patients to receive better treatment and care from pharmacists. Pharmacists are the patients’ first source of information [14]. Community pharmacies are well-positioned and can be effective in monitoring, educating, and counseling on sleep health. Their sleep health interventions can include educating people about sleep hygiene and lifestyle changes, as well as screening high-risk patients [19]. Although pharmacists play a key role in health care, previous studies have found that the majority of their work is confined to dispensing prescription medicines and providing counseling for OTC medicines [36]. Although in the present study, the quality of the relationship between patients and pharmacists was moderate and high in about half of the participants, since the role of communication in patients’ treatment process was found to be significant, the authors of this research believe that better communication with pharmacists may enhance the help-seeking behavior of patients regarding insomnia and improve their quality of life. Perhaps by improving this relationship, increasing trust in pharmacists, and providing a situation where patients are more clearly informed about medication options, people can more rationally deal with insomnia.

Given the high prevalence and large economic burden of insomnia, and given the fact that people do not tend to seek help when faced with insomnia, it is important that health care professionals are sensitive to the potential high risk of insomnia and follow up on this potential in order to ensure that people respond to treatment effectively. In order to improve the situation, we need more data on sleep behaviors and helpful approaches that are most likely to work for each patient.

In general, the results of this study reveal that health behaviors related to insomnia are rooted in the quality of people’s relationships with physicians and pharmacists. Society needs to improve the quality of patient-physician and patient-pharmacist interactions in order to enhance rational behavior against insomnia. Also, the high prevalence of self-medication among insomnia sufferers underscores the importance of informing, educating, and raising public awareness about the proper and safe methods of self-care and when to seek help from healthcare professionals.

One major limitation of this study was that it occurred during a global pandemic, creating a situation where many people were being surveyed online. This limited the study pool to those who could afford cell phones and social media accounts, and the study did not cover the most marginalized groups in society. People with lower incomes and education levels were less likely to have access to a cell phone or internet—and therefore would not be included in the survey. Because psychiatric disorders are uncomfortable to acknowledge, people often do not admit to having them. Similarly, taking psychiatric medications and self-medication are also taboo in society—so it is unsurprising that some respondents would have been unwilling or unable to answer these questions honestly. Another limitation was that the survey only covered one country. It is unclear whether similar results would be found in other countries, especially those with high rates of stigma and access to psychiatric medications.

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