One in Four Clinicians Battle Self-Medicated Insomnia

More than 25% of healthcare professionals in Spain experience moderate-to-severe insomnia and report using psychiatric or sleep-inducing medications that are often self-prescribed.

These findings are from a recent study published in Journal of Clinical Medicine and were presented at the 33rd Annual Meeting of the Spanish Sleep Society. 

From March 2023 to January 2024, researchers conducted an online, cross-sectional survey of 1121 healthcare professionals at the University of Salamanca Health Care Complex, Salamanca, Spain. They assessed the prevalence of insomnia among healthcare professionals, identified those needing clinical intervention, analyzed shift work as a potential risk factor, and explored associations with COVID-19 sequelae and psychiatric comorbidities. 

Carlos Roncero, MD, PhD, professor of psychiatry at the University of Salamanca, former head of the Addiction and Dual Diagnosis Unit at Hospital Vall d’Hebron in Barcelona, Spain, and president of the Spanish Society of Dual Pathology, told Medscape Spanish that “mental health programs during the SARS-CoV-2 pandemic revealed widespread sleep disturbances among healthcare professionals, patients, and their families. So, the need to study post-pandemic sleep problems in healthcare workers was recognized, which led to initiation of the Mental Health Support Program and the psychiatry service provided care for COVID-19 patients, their families, and healthcare workers,” he said. 

The Study

Overall, 22.7% of the participants reported moderate insomnia, and 3% reported severe insomnia. Nearly 30% of the respondents screened positive for depression (28.4%) or anxiety (33%).

“We have not observed major disparities based on professional role. However, there are differences by gender and age: Women tend to report more sleep problems, and insomnia is more common among older individuals. Prior COVID-19 infection, shift work, and coexisting mental health conditions such as depression or anxiety also contribute,” said Roncero regarding possible differences in prevalence based on the healthcare profession.

The study specifically found that the risk for insomnia was 3.1 times higher among healthcare workers who had contracted COVID-19 and experienced after-effects — a finding the authors described as highly significant.

Regarding whether this impact on sleep has persisted or diminished over time, Roncero explained, “Our study is cross-sectional, but previous studies showed even higher rates of sleep disorders, so we assume that this problem has decreased. However, it is possible that the prevalence detected already has a ‘floor effect,’ so they will not decrease further if specific actions are not implemented.”

Underdiagnosis and Self-Prescribing

The high rate of underdiagnosis of this condition is also notable. Only 3.1% of the total population had sleep disorder traits. This frequency seems low, considering the negative impact of insomnia on productivity and cognitive functioning in the medical profession. 

“More than 25% of health professionals have sleep problems, particularly insomnia. However, few patients are receiving treatment for this problem, and approximately 30% are receiving medication. There are several factors: on the one hand, the lack of recognition of insomnia and other sleep disorders as symptoms or a significant problem. On the other hand, there is little fear of self-medication with hypnotics. In this sense, the lack of awareness of the need to seek help and, therefore, to be diagnosed and treated is a problem that must be addressed,” Roncero said. 

Roncero also highlighted the high prevalence of psychiatric or sleep-aid medication use among this group. Specifically, 23.3% of healthcare workers reported taking medication at least once a month to help with their sleep problems.

“This is an important finding, given that it is higher than that of the general population. Therefore, it is essential that healthcare professionals receive support when taking these medications, something that does not always occur. In fact, in 27% of cases, these medications are self-prescribed by healthcare workers themselves, so they cannot be monitored by another professional who can objectively assess their need, dosage, and treatment duration,” he said.

Measures

María José Martínez, PhD coordinator of the Chronobiology Working Group of the Spanish Sleep Society, shared a similar perspective, although she was not involved in the study. In a statement to Medscape Spanish, she described the high rate of medication use and self-prescription as a “worrying warning sign,” citing the risk of “chronicizing insomnia and promoting tolerance and dependence without addressing the circadian origin of the problem.”

“Therefore, specific sleep hygiene education programs should be implemented, along with access to nonpharmacological interventions such as cognitive behavioral therapy for insomnia, and counseling on chronobiology applied to shift work. Furthermore, it is urgent to create confidential and accessible psychological care pathways for healthcare professionals, particularly following the COVID-19 pandemic,” she emphasized. 

The study confirmed that psychiatric comorbidities and sleep problems were more prevalent among shift and on-call workers and aligned with existing evidence that points to shift work as a major aggravating factor for insomnia. Extended hours and high-pressure conditions, particularly long shifts, are stressful circumstances that affect resilience and mental health outcomes among healthcare workers.

“This study reinforces and extends previous evidence, showing that shift work — particularly with frequent rotations — is associated with a significantly higher prevalence of insomnia and poor sleep quality in healthcare professionals,” Martínez said.

“Although we already knew that circadian desynchronization is a key factor, this study quantifies the impact in a real-life setting and with a representative sample of different healthcare profiles. Furthermore, it highlights the cumulative burden this chronic sleep disturbance places on a group already vulnerable due to their work and emotional demands,” she added.

Martínez outlined the serious consequences of sleep problems among shift workers, noting increased risks for metabolic, cardiovascular, immune, and psychiatric disorders, including depression and anxiety.

“From a cognitive and functional perspective, lack of sleep reduces sustained attention, decision-making, and the ability to respond flexibly to complex clinical situations, which can compromise patient safety and increase the risk for errors. Added to this is the fact that accumulated fatigue diminishes motivation and promotes burnout,” she explained.

“All this evidence should prompt reflection on the detection, evaluation, and diagnostic processes we have implemented in the various healthcare centers,” Roncero stated.

“Insomnia and sleep impairment continue to be normalized as ‘part of the job’ in hospital culture. At the institutional level, it is key to recognize sleep as a pillar of occupational health and clinical safety,” Martínez said. She noted that while awareness is growing among medical professionals and institutions, it remains insufficient.

Martínez and Roncero emphasized the need to implement measures in this regard.

Martínez proposed several practical measures that should be adopted: “Restructure shifts to align with circadian rhythms by avoiding rapid rotations and back-to-back night shifts; train human resources professionals in chronobiology; and implement real rest policies, including for residents. Sleep should also be a standard component of occupational health evaluations.”

When asked whether follow-up studies are planned, Roncero said, “we are currently assessing benzodiazepine use in this population and exploring the need for early detection and support programs for professionals with sleep disorders. We are also examining how these sleep problems are associated with professional development and personal repercussions.”

Carlos Roncero and María José Martínez declared having no relevant financial conflicts of interest. 

This story was translated from Medscape’s Spanish edition.