Up all night: The medicalization of sleeplessness.

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]