Management of Insomnia in Office-Based Practice

National Prevalence and Therapeutic Patterns
Stephen E. Radecki, PhD, Stephen A. Brunton, MD

Objectives: To identify the characteristics of patients who present to office-based physicians with complaints of , the physicians’ diagnoses related to these complaints, and the use of prescription sleep medications.

Methods: Based on 1989 and 1990 data from the National Ambulatory Medical Care Survey, with 3105 physicians participating (response rate, 74%). Participating physicians recorded data for a total of 81 853 patient visits. Patient characteristics, presenting complaint, diagnosis of condition, and pharmacologic therapy were included.

Results: Annually, there are 3.3 million visits to officebased physicians for complaints of insomnia, 65% of which are to primary care specialists. Rates of insomnia visits are somewhat higher for middle-aged (45 to 64 years of age) women, and data for female insomniacs suggest a trend toward diagnoses of depression compared with other (somatic) for men. The prescribing of long\x=req-\ acting sleep medications does not differ significantly by physician specialty, but it declines with increasing patient age.

Conclusions: Physician visits for insomnia account for only a small proportion of office visits but offer the opportunity for identification of underlying illnesses and for the prevention of associated problems. While some differences in diagnosis are associated with patient characteristics (possibly reflecting a bias in the workup), sleep medications appear to be prescribed appropriately, with a declining rate in the prescribing of long-acting medications for older patients.

(Arch Fam Med. 1993;2:1129-1134)

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Randy Clare

Randy Clare

Randy Clare brings to The Sleep and Respiratory Scholar more than 25 years of extensive knowledge and experience in the sleep and pulmonary function field. He has held numerous management positions throughout his career and has demonstrated a unique view of the alternate care diagnostic and therapy model. He is considered by many an expert in the use of oral appliances like Silent Nite, EMA and TAP to treat snoring and sleep apnea in the dental office. Mr. Clare's extensive sleep industry experience assists Sleepandrespiratoryscholar in providing current, relevant, data-proven information on sleep diagnostics and sleep therapies that are effective for the treatment of sleep disorders. Mr Clare is director of business development for Glidewell a dental solutions company his focus is on dental treatment for sleep disordered breathing.

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