SLEEP MEDICATIONS

Patient Characteristics and Patterns of Drug Use for Sleep Complaints in the United States: Analysis of National Ambulatory Medical Survey Data, 1997-2002

Robert J. Morlock, PhD; Maudrene Tan, MS; and David Y. Mitchell, PhD

Commentary by Alan Lyles, ScD, MPH, RPh
Section Co-Editor, Pharmaceutical Economics & Health Policy
Division of Government and Public Administration
University of Baltimore

A nationally representative survey—the National Ambulatory Medical Care Survey (NAMCS)—was used to examine sleep complaints and their treatment during 1997–2002. Results from the NAMCS are described by Morlock et al in "Patient Characteristics and Patterns of Drug Use for Sleep Complaints in the United States: Analysis of National Ambulatory Medical Survey Data, 1997–2002" (Clin Ther 2006;28:1044–1053). In the NAMCS, the estimate of 5 million office visits with insomnia as a primary or secondary complaint was substantially increased from 1989 and 1990 (~3.3 million), but the patient demographic characteristics were similar, with most patients being women aged 45 to 65 years (among adolescents, males more commonly sought treatment). Among patients aged >65 years, organic disease was the most common diagnosis associated with insomnia. Primary care physicians (PCPs) provided care to most (63.9%) of these patients, but 19.3% were seen by psychiatrists. A small percentage (0.6%) discussed sleep complaints with their physicians, but in a patient survey, 52% of patients with probable insomnia reported discussing it with their physicians. In cases in which pharmacotherapy was recommended, the specific agents prescribed varied by the specialty of the physician and the sex, age, and primary diagnosis of the patient. PCPs prescribed a variety of products, most commonly newer agents (zaleplon or zolpidem). Trazodone was recommended more often overall (32% vs 28.3% for newer hypnotics), but mainly for a diagnosis of depression, anxiety, or both (52.8%). This study identifies disparities in patient and physician communications about insomnia, potentially leading to underdiagnosis and treatment.

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