摘要：Sleeplessness, a universal condition with diverse causes, may be increasingly diagnosed and treated (or medicalized) as insomnia. We examined the trend in sleeplessness complaints, diagnoses, and prescriptions of sedative hypnotics in physician office visits from 1993 to 2007. Consistent with the medicalization hypothesis, sleeplessness complaints and insomnia diagnoses increased over time and were far outpaced by prescriptions for sedative hypnotics. Insomnia may be a public health concern, but potential overtreatment with marginally effective, expensive medications with nontrivial side effects raises definite population health concerns. The occasional inability to sleep, or sleeplessness, is part of the universal human experience and has been recorded by ancient and modern authors. 1 – 4 Recently, however, sleeplessness has been characterized as an epidemic 5 and an unmet public health problem. 6 Insomnia diagnoses in the United States, which appear to be increasing, are associated with poor health outcomes and may cost $100 billion annually in health services, accidents, and lost productivity. 7 – 9 It is unclear, however, if the United States is facing a true insomnia epidemic or a surplus of diagnoses and drug prescriptions. 10 Sleep patterns are influenced by changing cultural norms, shifting demographics (adults ≥ 65 years are more likely to be sleepless 11 ), and increased use of technology. 6 , 12 , 13 Awareness raised by public health and pharmaceutical agencies may facilitate new diagnoses. 14 , 15 Medicalization may also contribute to the increased perception, diagnosis, and treatment of sleeplessness as the medical condition insomnia. 3 Medicalization is the process by which formerly normal biological processes or behaviors come to be described, accepted, or treated as medical problems. 16 The process is value neutral, but outcomes affect individual and public health. 16 Medicalization may raise awareness about and improve access to beneficial medical treatments for previously underrecognized disorders. 17 Conversely, it may reframe and transform ideas of physical and emotional normalcy prompting the overuse of potentially harmful drugs or surgery. 18 , 19 Excessive or inappropriate use of medical solutions to treat life problems may negatively affect public health. 10 , 17 – 19 We explored the idea that the US epidemic of insomnia may be, in part, facilitated by medicalization. Explorations of medicalization are typically qualitative and focus on the conceptual nature of the disorder. 17 Sleep is no exception. 20 – 23 Our research is the first to our knowledge to focus on the measurable outcomes of the patient–physician interaction surrounding sleeplessness and the public health implications. Using nationally representative office visit data we measured trends over time in (1) complaints of sleeplessness, (2) diagnoses of insomnia, and (3) prescriptions of sedative hypnotics. Medicalization theory predicts an increasing incidence of insomnia diagnoses and treatments over time that outpace sleeplessness complaints, particularly among younger adults.
