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Previous analysis of U.S. physician office visits (1993-2007) indicated that the medicalization of sleeplessness was on the rise and had potentially negative implications for population health. Our study asks if the medicalization of sleeplessness at the level of patient-physician interaction has persisted over time. Using the most recent years available (2008-2015) of the National Ambulatory Medical Care Survey we calculated nationally representative estimates for four sleeplessness-related outcomes of physician office visits: sleeplessness complaint, insomnia diagnosis, and prescription of benzodiazepine and non-benzodiazepine sedative-hypnotics (NBSH). To test for the significance of the linear trajectory, we ran a series of bivariate linear models. We tested three hypotheses grounded in the medicalization framework: if the medicalization of sleeplessness at the interactional level is continuing at a rate comparable to previous analyses, sleeplessness-related outcomes will continue to increase significantly over time (Hypothesis 1); NBSH prescriptions and insomnia diagnoses will continue to outpace sleeplessness complaints (Hypothesis 2); and insomnia diagnoses and use of sedative-hypnotics will increase or remain concentrated among age groups who lack the changing sleep patterns and commonly occurring comorbidities associated with older age (Hypothesis 3). Support for these hypotheses was mixed. Unlike previous analyses wherein all sleeplessness-related outcome trends were positive and statistically significant over time, regression analyses revealed a significant negative NBSH prescription trend 2008-2015 (slope, b = -699,628, P<0.05). No other associations were significant. Younger age groups were most likely to receive an insomnia diagnosis and NBSH prescription. These trends imply that the medicalization of sleeplessness at the level of patient-physician interaction may be on the decline. We suggest that increasingly negative portrayals of sedative-hypnotics, conservative practice recommendations, and decreased direct-to-consumer advertising for NBSH may decrease consumerism and physician compliance related to the medicalization of sleeplessness. We conclude with a discussion on non-pharmaceutical methods of reducing sleeplessness relevant to population health. [ABSTRACT FROM AUTHOR]

Sleeplessness, a universal experience with a variety of causes, is being proclaimed an "epidemic" and is increasingly re-conceptualized and diagnosed, or medicalized, as insomnia. I hypothesize that increasing consumerism among patients and the influence of the pharmaceutical industry may be mediating the patient-physician interaction and contributing to the medicalization of sleeplessness at the interactional level. I will answer the question: Is there evidence of the medicalization of sleeplessness, or insomnia, at the level of patient-physician interaction?I employ a mixed methods design. First, I will analyze data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative data set of office-based physician visits. Secondly, I conduct interviews with patients who seek medical attention for insomnia and the physicians who treat them.Expected results: Analysis of NAMCS (for the 10-year period 1996-2005) will demonstrate increased probability that an office visit: will be the result of a chief complaint of sleeplessness; will result in a diagnosis of insomnia; and will result in the prescription of a sedative hypnotic. Prescriptions of sedative hypnotics will not be dependent on a diagnosis of insomnia.Patient (n=20-30) and physician (n=10-15) interviews may reveal that patients enter the office visit with a self-diagnosis of insomnia and ask for prescription sedatives by name. Physicians may prescribe brand-name drugs to facilitate patient compliance. [ABSTRACT FROM AUTHOR]

Using secondary data analysis of seven focus groups and two in-depth interviews, I explore the stigmatization of women with disabilities in the organizational context of the workplace. I highlight the role of stereotypes in the construction of perceived and actual identity and strategies for coping with stigma. "Going the extra mile" is introduced as a compensatory behavioral strategy discussed by women with higher social and economic capital. Results indicate a need for further investigation of successful coping strategies among sub-populations of individuals with disabilities and the possible role of human and social capital in successful stigma coping techniques. [ABSTRACT FROM AUTHOR]

Sleeplessness is linked to individual and large scale health issues in the U.S. However, the medicalization of sleeplessness - a process that utilizes the diagnostic entity of insomnia and offers predominantly pharmacological solutions - may also pose substantial risk to personal and public health. So who is most affected by the medicalization of sleeplessness? Older age, female gender, Caucasian race, mental illness and low socio-economic status are highly correlated with insomnia diagnosis. Older adults, in particular, may have a narrower therapeutic window and thus are at greater risk of falls, cognitive difficulties and accidents. Sleep aids may also be risky for patients who take multiple medications, have histories of mental illness or problems with substance abuse. While certain risk factors for insomnia and its treatment have been well-identified, little is known of how age interacts with other socio-demographic characteristics such as race and sex and how these interactions may in turn predict specific insomnia-related outcomes such as insomnia complaint, diagnosis and prescription of a sleep drug. Using a nationally representative dataset of physician office visits, this paper builds on previous research and explores the socio-demographic factors associated with sleeplessness while highlighting the effects of age on insomnia-related office visit outcomes. Implications for policy are discussed. [ABSTRACT FROM AUTHOR]