Insomnia symptoms and subsequent psychotropic medication: a register-linked study with 5-year follow-up

Association Between Insomnia and Healthcare Utilization: A Scoping Review of the Literature

Insomnia is a sleep disorder that affects significant portion of the population. It can result in adverse health outcomes and increased healthcare utilization. The purpose of this review was to identify existing research on the association between insomnia and healthcare utilization. A five-stage scoping review process was conducted guided by the Joanna Briggs Institute process. Data sources searched through 2022 were PubMed, HINARI, Google Scholar and Cochrane, with additional studies identified through hand searching. Descriptive and exploratory analyses were conducted from the findings of the selected studies. After reviewing 124 references, 23 studies were selected. A strong and positive association between insomnia and healthcare utilization and healthcare costs was identified. We also found that insomnia was associated with absenteeism from work, lower work performance ratings, disability, difficulties in daily activities, and life dissatisfaction. An unexpected theme that emerged from the included studies is that there is a large population with persistent insomnia who do not seek help that could benefit from improved management. Findings suggest that identifying and managing insomnia could result in a decrease in healthcare utilization and costs. Further research is needed to determine the most effective methods of identifying and managing insomnia.

Association of rotating shift work schedules and the use of prescribed sleep medication: A prospective cohort study

We examined whether working rotating shifts, with or without night work, is associated with the purchase of prescribed sleep medication, and whether the association is dependent on age. Data were obtained from a longitudinal cohort study of Finnish public sector employees who responded to questions on work schedule and background characteristics in 2000, 2004 and 2008. The data were linked to national register data on redeemed prescriptions of hypnotic and sedative medications, with up to 11 years of follow-up. Age stratified Cox proportional hazard regression models were computed to examine incident use of medication comparing two groups of rotating shift workers (those working shifts that included night shifts and those whose schedules did not include night shifts) with day workers who worked in a similar range of occupations. Shift work with night shifts was associated with increased use of sleep medication in all age groups, after adjustments for sex, occupational status, marital status, alcohol consumption, smoking and physical activity levels (hazard ratio [HR], [95% confidence interval, CI] 1.14 [1.01-1.28] for age group ≤39 years; 1.33 [1.19-1.48] for age group 40-49 years; 1.28 [1.13-1.44] for age group ≥50 years). Shift work without nights was associated with medication use in the two older age groups (HR [95% CI] 1.14 [1.01-1.29] and 1.17 [1.05-1.31] for age groups 40-49 years and >50 years, respectively). These findings suggest that circadian disruption and older age puts rotating shift workers, and especially those who work nights, at increased risk of developing clinically significant levels of sleep problems.

Early predictors of impaired sleep: a study on life course socioeconomic conditions and sleeping problems in older adults

Objectives: This study aimed to assess how childhood socioeconomic conditions are associated with sleeping problems in older adults and how this association may be mediated by socioeconomic conditions across the lives of individuals using a life course perspective. Since the life course opportunities differ systematically between men and women, attention was given to gender differences in the association.Methods: Data from 23,766 individuals aged over 50 years of the longitudinal Survey of Health, Ageing and Retirement in Europe (SHARE) were used. Logistic mixed-effect models were estimated to examine the associations between childhood socioeconomic conditions and the presence of sleeping problems.Results: For women, the analyses showed an association between childhood socioeconomic conditions and sleeping problems. For men, only current socioeconomic conditions were found to be relevant for sleep. The importance of childhood socioeconomic conditions for sleeping problems did not affect the evolution of sleeping problems over ageing.Conclusion: In this study no empirical support was found for processes of cumulative advantage/disadvantage or age-as-leveler. However, childhood does seem to be a critical period for the sleep of women, because the association with childhood socioeconomic conditions remains even when the circumstances later in life are considered. These findings, in particular the gender differences in the association, underline the importance of tracking life course patterns in the study of sleeping problems in older adults.

Complementary and Alternative Medicine for the Treatment of Insomnia: An Overview of Scientific Evidence from 2008 to 2018

Insomnia is a widespread sleep disorder in the general population, and it is a risk factor for impaired function, the development of other medical and mental disorders, and causes an increase in health care costs. In view of the health hazards of insomnia and the shortcomings of western medicine, Complementary and Alternative Medicine (CAM) should be considered in the management of insomnia. The present overview reports the potential role of herbal medicine and non-pharmacological therapies in the treatment of insomnia and summarizes the scientific evidence reported from 2008 to 2018. PubMed and Web of Science databases were searched for studies published from 2008 to 2018. 17 randomized controlled trials and 22 non-pharmacological therapies were included in this review, and the results showed that CAM had certain advantages in the treatment of insomnia. The safety of CAM for insomnia was acceptable. Meanwhile, based on pre-clinical trial, the possible mechanisms of CAM for insomnia were modulation of circadian rhythm, GABA receptor activation, antagonisms of 5-HT receptors, inhibition of glutamate-mediated pathways, and attenuation of inflammation. CAM for insomnia has made some progress, but high quality evidence-based medical evidence is still needed to provide guidance for clinical application.

Psychotropic use patterns: Are there differences between men and women?

This study analyzed differences between men and women regarding the use of psychotropic drugs and associated factors in a population of adults and seniors in the city of Campinas, Brazil. A population-based, cross-sectional study was conducted using data from the ISACamp 2014/2015 health survey in the city of Campinas. The sample was composed of 1999 individuals aged 20 years or older. For each sex, prevalence rates and prevalence ratios were estimated for the use of psychotropic drugs according to demographic characteristics, socioeconomic characteristics, health problems, degree of limitation and type of emotional/mental problem. The most used classes of medications were also determined. The prevalence of the use of psychotropic drugs was 11.7% (7.3% among men and 15.8% among women). The most common therapeutic classes were antidepressants (38.2%) and benzodiazepines (24.0%). The frequency of antidepressant use was higher among women (44.3%) than men (25.5%). Regarding associated factors, reports of emotional/mental problems were associated with the greater use of this type of drug in both sexes. Among the men, white skin color, a lack of an occupational activity, a greater number of complaints of health problems and the occurrence of insomnia were associated with the use psychotropic drugs. Among the women, a significant increase in the use of these drugs was found with the increase in age and higher prevalence rates were found among those with a higher level of schooling, those with a greater number of diagnosed chronic diseases and those with a common mental disorder. The present results confirm the greater use of psychotropic agents, especially antidepressants, in the female sex and reveal that the pattern of associated factors differs between sexes. It is therefore necessary to understand the peculiarities of each sex that exert an influence on the perception of health problems and the desire to seek care, which, in turn, affect the use of psychotropic agents.

Medicalization of Sleep Problems in an Aging Population: A Longitudinal Cross-National Study of Medication Use for Sleep Problems in Older European Adults

Objective: The association between age and sleep problems is considered to be positive, and medication use is a common health care intervention among older individuals. Because daytime consequences are often stated as a reason to seek care, we study to what extent the medicalization of sleep problems is found in an aging European population, with a focus on daily activities. Method: Data from the Survey of Health Ageing and Retirement in Europe are used in three-level, generalized linear mixed models. Medicalization is operationalized as the use of medication for sleep problems at least once per week. Results: Men are more likely than women to use medication for sleep problems, and the process of aging is associated with a decrease in medicalization. Discussion: Sleep problems seem to be medicalized particularly when they prevent aging individuals from engaging in work-related responsibilities, as medication is especially used by employed individuals with sleep problems.