A patient’s likelihood of being prescribed a drug for a sleep problem is higher when the patient is older, a female, or White, according to a study in the June 1 issue of the journal Sleep.
The study shows that people who are 65 years and older are almost five times as likely to receive a drug prescription after an outpatient office visit related to a sleep problem, when compared to patients who are 18 to 35 years of age. Men are 29% less likely than women to be prescribed a drug for sleep, while White patients are 68% more likely than non-White patients to receive a prescription for a sleep difficulty. Overall, physicians are more likely to prescribe a drug to treat a sleep problem for returning, rather than new, patients.
About 30 percent of patients treated in primary care settings complain of having trouble sleeping, according to background information in the article. Worldwide, insomnia is the most common sleep complaint, and about 20 percent of patients seen by primary care doctors in the United States have chronic insomnia. Along with behavioral therapy, pharmacologic treatments are often used for cases of insomnia.
Rajesh Balkrishnan, Ph.D., of Ohio State University College of Pharmacy, and colleagues see in the results of their study important implications for the practice of sleep medicine.
“This study suggests an urgent need to develop better care management and patient and physician awareness programs for treatment of sleep difficulties,” says Dr. Balkrishnan. “Different predictors of treatment options should be considered to create consciousness at both physicians' and patients' ends regarding appropriate treatment.”
The study also shows differences in the type of drug prescribed to treat a sleep problem. Among patients receiving a drug prescription for sleep, the drug is more likely to be a benzodiazepine for people who are either 65 years or older, on public insurance (Medicare and Medicaid), or who also have a mental problem. Conversely, nonbenzodiazepines are much more likely to be prescribed by psychiatrists than by other physicians.
According to Balkrishnan, while the older benzodiazepines are cheaper than newer medications, they are also more likely to cause addiction.
“Some of the most vulnerable populations in the U.S., such as the elderly and those receiving some type of public insurance, are more likely to receive older pharmacotherapies with higher abuse potential,” says Balkrishnan. “The reasons for these trends should be thoroughly explored and remedial actions taken to stop this trend.”
Data for the study were drawn from the National Ambulatory Medical Care Survey (NAMCS) of 1996 — 2001, which assesses patients’ office visits from a national sample of office-based physicians. The NAMCS contains a total of 150,269 unweighted outpatient visits to office physicians. This represents a total of 4.8 billion visits nationwide.
The study sample size consisted of 2,966 unweighted patient visits for insomnia or other sleep-related problems, which represents a total of 94.6 million visits for the entire U.S. population over the six-year-period of the survey.
This study was supported by a research grant from Takeda Pharmaceuticals of North America, Inc.
The journal Sleep is the official publication of the Associated Professional Sleep Societies, LLC, a joint venture of the American Academyof Sleep Medicine and the Sleep Research Society. It is a peer-reviewed research and clinical journal addressing sleep, circadian rhythms, and the diagnosis and treatment of the broad spectrum of sleep disorders.