Management of insomnia in office-based practice. National prevalence and therapeutic patterns

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

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.

Annually, there are 3.3 million visits to office-based 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) diagnoses for men. The prescribing of long-acting sleep medications does not differ significantly by physician specialty, but it declines with increasing patient age.

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.