A narrative review and model for sleep health equity in South African healthcare

Abstract

Background: Insomnia disorder (ID) is a prevalent but often overlooked sleep disorder characterised by persistent difficulties initiating or maintaining sleep, with significant health consequences. Global prevalence ranges from 5% to 50%, with South African rates at 8%, rising to over 20% in vulnerable populations. ID presents substantial physical, psychological, and socio-economic challenges.
Aim: This review examines ID as a complex clinical condition affecting both patients and healthcare practitioners (HCPs). It analyses global and local management practices and disparities within South Africa’s public health system, highlighting the need for sleep equity. A key motivation is to advocate for routine sleep discussions during consultations to encourage early behavioural intervention and prevent chronic ID.
Setting: The study was conducted within South Africa’s public health system, where limited resources, high patient loads, and inequitable access to care shape how sleep disorders are recognised and managed.
Methods: A literature review was conducted using Google Scholar, EBSCOhost, and PubMed, focusing on peer-reviewed studies from lower-middle- to high-income countries, with emphasis on South Africa.
Results: Of 186 articles identified, 15 seminal papers were retained and analysed to inform findings on ID management.
Conclusion: This narrative review explores the multifactorial aetiology, clinical assessment, diagnosis, and management of ID, highlighting disparities between global best practices and South Africa’s dual healthcare system. It advocates early intervention through routine sleep inquiries, behavioural therapies, and multidisciplinary collaboration, while identifying directions for future research.
Contribution: As the most common sleep disorder, ID remains underdiagnosed and undertreated. This review proposes a pathway to strengthen management and improve outcomes.