Quality of Life Research

, Volume 24, Issue 5, pp 1223–1233 | Cite as

Insomnia, hypnotic use, and health-related quality of life in a nationally representative sample

Article

Abstract

Purpose

To assess health-related quality of life (HRQoL) associated with insomnia and prescription hypnotic use.

Methods

Primary outcomes were mental component summary (MCS) and physical component summary (PCS) scores from the 12-item Short-Form Health Survey. Using multiple regression, subjects in the 2005 through 2009 Medical Expenditure Panel Survey with diagnosed insomnia were compared against those without that diagnosis. Among subjects with diagnosed insomnia, users of prescription hypnotics were compared against nonusers.

Results

Of 104,274 adults, 1.3 % (n = 1,401) had an insomnia diagnosis. Of those, 45.6 % (n = 639) used prescription hypnotics. For subjects with insomnia, mean PCS and MCS scores were 9.2 and 7.0 points lower (p < 0.001), respectively. After controlling for demographic and clinical covariates, differences remained significant (PCS:5.1; MCS:6.2; p < 0.001). Among subjects with insomnia, HRQoL scores were not different between prescription hypnotic users (n = 639) and nonusers (n = 762). Analysis by drug class revealed lower PCS scores (difference: 7.5, p < 0.001) with benzodiazepine use (n = 129) versus benzodiazepine receptor agonist use (n = 493), but the adjusted difference was not significant (difference: 3.8, p = .018).

Conclusions

Diagnosed insomnia was associated with consistent decreases in both physical and mental HRQoL scores, regardless of whether prescription hypnotics were used. Benzodiazepine use may be associated with a further decrease in physical HRQoL scores. Although limited by its retrospective design, this study provides a first look at real-world hypnotic use outcomes at a national level. Important next steps include studies with patients serving as their own controls, and further evaluation of the sensitivity of HRQoL instruments to the effects of insomnia treatments.

Keywords

Health-related quality of life Insomnia Sleep Hypnotic SF-12 MEPS 

References

  1. 1.
    Léger, D., & Poursain, B. (2005). An international survey of insomnia: Under-recognition and under-treatment of a polysymptomatic condition. Current Medical Research and Opinion, 21, 1785–1792.CrossRefPubMedGoogle Scholar
  2. 2.
    Morin, C. M., LeBlanc, M., Daley, M., Gregoire, J. P., & Mérette, C. (2006). Epidemiology of insomnia: Prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Medicine, 7, 123–130.CrossRefPubMedGoogle Scholar
  3. 3.
    Stepanski, E., Koshorek, G., Zorick, F., Glinn, M., & Roehrs, T. (1989). Characteristics of individuals who do or do not seek treatment for chronic insomnia. Psychosomatics, 30(4), 421–427. doi: 10.1016/S0033-3182(89)72248-9.
  4. 4.
    Roth, T., Coulouvrat, C., Hajak, G., Lakoma, M. D., Sampson, N. A., Shahly, V., et al. (2011). Prevalence and perceived health associated with insomnia based on DSM-IV-TR; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition Criteria: Results from the America Insomnia Survey. Biological Psychiatry, 69, 592–600.CrossRefPubMedGoogle Scholar
  5. 5.
    Léger, D., Morin, C. M., Uchiyama, M., Hakimi, Z., Cure, S. S., & Walsh, J. K. (2012). Chronic insomnia, quality-of-life, and utility scores: Comparison with good sleepers in a cross-sectional international survey. Sleep Medicine, 13, 43–51.CrossRefPubMedGoogle Scholar
  6. 6.
    Komada, Y., Nomura, T., Kusumi, M., Nakashima, K., Okajima, I., Sasai, T., et al. (2012). A two-year follow-up study on the symptoms of sleep disturbances/insomnia and their effects on daytime functioning. Sleep Medicine, 13, 1115–1121.CrossRefPubMedGoogle Scholar
  7. 7.
    Sasai, T., Inoue, Y., Komada, Y., Nomura, T., Matsuura, M., & Matsushima, E. (2010). Effects of insomnia and sleep medication on health-related quality of life. Sleep Medicine, 11, 6.CrossRefGoogle Scholar
  8. 8.
    Lee, M., Choh, A. C., Demerath, E. W., Knutson, K. L., Duren, D. L., Sherwood, R. J., et al. (2009). Sleep disturbance in relation to health-related quality of life in adults: The Fels Longitudinal Study. The Journal of Nutrition, Health and Aging, 13, 576–583.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Bolge, S. C., Doan, J. F., Kannan, H., & Baran, R. W. (2009). Association of insomnia with quality of life, work productivity, and activity impairment. Quality of Life Research, 18, 415–422.CrossRefPubMedGoogle Scholar
  10. 10.
    LeBlanc, M., Beaulieu-Bonneau, S., Mérette, C., Savard, J., & Ivers, H. (2007). Morin CM: Psychological and health-related quality of life factors associated with insomnia in a population-based sample. Journal of Psychosomatic Research, 63, 157–166.CrossRefPubMedGoogle Scholar
  11. 11.
    Schubert, C. R., Cruickshanks, K. J., Dalton, D. S., Klein, B. E. K., Klein, R., & Nondahl, D. M. (2002). Prevalence of sleep problems and quality of life in an older population. Sleep, 25, 889–893.PubMedGoogle Scholar
  12. 12.
    Katz, D. A., & McHorney, C. A. (2002). The relationship between insomnia and health-related quality of life in patients with chronic illness. Journal of Family Practice, 51, 229–235.PubMedGoogle Scholar
  13. 13.
    Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Lichstein, K. L., & Morin, C. M. (2006). Recommendations for a standard research assessment of insomnia. Sleep, 29, 1155–1173.PubMedGoogle Scholar
  14. 14.
    Krystal, A. D. (2007). Treating the health, quality of life, and functional impairments in insomnia. Journal of Clinical Sleep Medicine, 3, 63–72.PubMedGoogle Scholar
  15. 15.
    Kyle, S. D., Morgan, K., & Espie, C. A. (2010). Insomnia and health-related quality of life. Sleep Medicine Reviews, 14, 69–82.CrossRefPubMedGoogle Scholar
  16. 16.
    Ishak, W. W., Bagot, K., Thomas, S., Magakian, N., Bedwani, D., Larson, D., et al. (2012). Quality of life in patients suffering from insomnia. Innovations in Clinical Neuroscience, 9, 13–26.PubMedCentralPubMedGoogle Scholar
  17. 17.
    Hajak, G., Rodenbeck, A., Voderholzer, U., Riemann, D., Cohrs, S., Hohagen, F., et al. (2001). Doxepin in the treatment of primary insomnia: A placebo-controlled, double-blind, polysomnographic study. Journal of Clinical Psychiatry, 62, 453–463.CrossRefPubMedGoogle Scholar
  18. 18.
    Krystal, A. D., Walsh, J. K., Laska, E., Caron, J., Amato, D. A., Wessel, T. C., et al. (2003). Sustained efficacy of eszopiclone over 6 months of nightly treatment: Results of a randomized, double-blind, placebo-controlled study in adults with chronic insomnia. Sleep, 26, 793–799.PubMedGoogle Scholar
  19. 19.
    Asnis, G. M., Chakraburtty, A., DuBoff, E. A., Krystal, A. D., Londborg, P. D., Rosenberg, R., et al. (1999). Zolpidem for persistent insomnia in SSRI-treated depressed patients. Journal of Clinical Psychiatry, 60, 668–676.CrossRefPubMedGoogle Scholar
  20. 20.
    Walsh, J. K., Roth, T., Randazzo, A., Erman, M., Jamieson, A., Scharf, M., et al. (2000). Eight weeks of non-nightly use of zolpidem for primary insomnia. Sleep, 23, 1087–1096.PubMedGoogle Scholar
  21. 21.
    Lader, M. (2011). Benzodiazepines revisited—will we ever learn? Addiction, 106, 2086–2109.CrossRefPubMedGoogle Scholar
  22. 22.
    Bertisch, S. M., Herzig, S. J., Winkelman, J. W., & Buettner, C. (2014). National use of prescription medications for insomnia: NHANES 1999–2010. Sleep, 37, 343–349.PubMedCentralPubMedGoogle Scholar
  23. 23.
    Stahl, S. M. (2002). Selective actions on sleep or anxiety by exploiting GABA-A/benzodiazepine receptor subtypes. Journal of Clinical Psychiatry, 63, 179–180.CrossRefPubMedGoogle Scholar
  24. 24.
    McCall, C., & McCall, W. V. (2012). What is the role of sedating antidepressants, antipsychotics, and anticonvulsants in the management of insomnia? Current Psychiatry Reports, 14, 494–502.CrossRefPubMedGoogle Scholar
  25. 25.
    Medical Expenditure Panel Survey: Survey Overview: Slide Presentation from the AHRQ 2008 Annual Conference (Text Version). http://www.ahrq.gov/about/annualmtg08/091008slides/MoyBattles.htm
  26. 26.
    Medical Expenditure Panel Survey. http://www.meps.ahrq.gov/mepsweb/
  27. 27.
  28. 28.
    Gandek, B. (1998). Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. Journal of Clinical Epidemiology, 51, 903–912.CrossRefPubMedGoogle Scholar
  29. 29.
    Ware, J. E., Jr., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233.CrossRefPubMedGoogle Scholar
  30. 30.
    Léger, D., Scheuermaier, K., Paillard, M., & Guilleminault, C. (2001). SF-36: Evaluation of quality of life in severe and mild insomniacs compared with good sleepers. Psychosomatic Medicine, 63, 49–55.CrossRefPubMedGoogle Scholar
  31. 31.
    Le Guen, Y., Gagnadoux, F., Hureaux, J., Jeanfaivre, T., Meslier, N., Racineux, J. L., & Urban, T. (2007). Sleep disturbances and impaired daytime functioning in outpatients with newly diagnosed lung cancer. Lung Cancer, 58(1), 139–143. doi: 10.1016/j.lungcan.2007.05.021.
  32. 32.
    Vena, C. I., Parker, K. P., Allen, R., Bliwise, D. L., & Kimble, L. (2007). Sleep-wake disturbances and quality of life in patients with advanced lung cancer. Oncology Nursing Forum, 33, 761–769.CrossRefGoogle Scholar
  33. 33.
    Tsilika, E., Gennatas, C., Galanos, A., & Vlahos, L. (2008). How is sleep quality affected by the psychological and symptom distress of advanced cancer patients? Palliative Medicine, 23, 46–53.CrossRefPubMedGoogle Scholar
  34. 34.
    Cheak-Zamora, N. C., Wyrwich, K. W., & McBride, T. D. (2009). Reliability and validity of the SF-12v2 in the medical expenditure panel survey. Quality of Life Research, 18, 727–735.CrossRefPubMedGoogle Scholar
  35. 35.
    Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003). Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Medical Care, 41(5), 582–592. doi: 10.1097/01.MLR.0000062554.74615.4C.
  36. 36.
    Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.CrossRefPubMedGoogle Scholar
  37. 37.
    D’Hoore, W., Bouckaert, A., & Tilquin, C. (1996). Practical considerations on the use of the Charlson comorbidity index with administrative data bases. Journal of Clinical Epidemiology, 49, 1429–1433.CrossRefPubMedGoogle Scholar
  38. 38.
    Charlson, M., Szatrowski, T. P., & Peterson, J. (1994). Validation of a combined comorbidity index. Journal of Clinical Epidemiology, 47(11), 1245–1251. doi: 10.1016/0895-4356(94)90129-5.
  39. 39.
    Bootzin, R. R., & Epstein, D. R. (2011). Understanding and treating insomnia. Annual Review of Clinical Psychology, 7, 435–458.CrossRefPubMedGoogle Scholar
  40. 40.
    Meissner, H. H., Riemer, A., Santiago, S. M., Stein, M., Goldman, M. D., & Williams, A. J. (1998). Failure of physician documentation of sleep complaints in hospitalized patients. Western Journal of Medicine, 169, 146–149.PubMedCentralPubMedGoogle Scholar
  41. 41.
    Zisapel, N. (2012). Drugs for insomnia. Expert Opinion on Emerging Drugs, 17, 299–317.CrossRefPubMedGoogle Scholar
  42. 42.
    Rosen, R. C., Zozula, R., Jahn, E. G., & Carson, J. L. (2001). Low rates of recognition of sleep disorders in primary care: Comparison of a community-based versus clinical academic setting. Journal of Chronic Diseases, 2, 47–55.Google Scholar
  43. 43.
    Senthilvel, E., Auckley, D., & Dasarathy, J. (2011). Evaluation of sleep disorders in the primary care setting: History taking compared to questionnaires. Journal of Clinical Sleep Medicine, 7, 41–48.PubMedCentralPubMedGoogle Scholar
  44. 44.
    Morlock, R. J., Tan, M., & Mitchell, D. Y. (2006). Patient characteristics and patterns of drug use for sleep complaints in the United States: Analysis of National Ambulatory Medical Survey data, 1997–2002. Clinical Therapeutics, 28, 1044–1053.CrossRefPubMedGoogle Scholar
  45. 45.
    Lai, L. L., Tan, M. H., & Lai, Y. C. (2011). Prevalence and factors associated with off-label antidepressant prescriptions for insomnia. DHPS, 3, 27–36.CrossRefGoogle Scholar
  46. 46.
    Roehrs, T., & Roth, T. (2004). “Hypnotic” prescription patterns in a large managed-care population. Sleep Medicine, 5, 463–466.CrossRefPubMedGoogle Scholar
  47. 47.
    Pawaskar, M. D., Joish, V. N., Camacho, F. T., Rasu, R. S., & Balkrishnan, R. (2008). The influence of co-morbidities on prescribing pharmacotherapy for insomnia: Evidence from US national outpatient data 1995–2004. Journal of Medical Economics, 11, 41–56.CrossRefPubMedGoogle Scholar
  48. 48.
    Ohayon, M. M. (2002). Epidemiology of insomnia: What we know and what we still need to learn. Sleep Medicine Reviews, 6, 15.CrossRefGoogle Scholar
  49. 49.
    Ohayon, M. M., & Roth, T. (2001). What are the contributing factors for insomnia in the general population? Journal of Psychosomatic Research, 51, 745–755.CrossRefPubMedGoogle Scholar
  50. 50.
    Swanson, L. M., Arnedt, J. T., Rosekind, M. R., Belenky, G., Balkin, T. J., & Drake, C. L. (2011). Sleep disorders and work performance: Findings from the 2008 National Sleep Foundation Sleep in America poll. Journal of Sleep Research, 20, 487–494.CrossRefPubMedGoogle Scholar
  51. 51.
    Ozminkowski, R. J., Wang, S., & Walsh, J. K. (2007). The direct and indirect costs of untreated insomnia in adults in the United States. Sleep, 30, 263–273.PubMedGoogle Scholar
  52. 52.
    Buysse, D. J., Grunstein, R. R., Horne, J. J., & Lavie, P. P. (2010). Can an improvement in sleep positively impact on health? Sleep Medicine Reviews, 14(6), 405–410. doi: 10.1016/j.smrv.2010.02.001.
  53. 53.
    Rombaut, N., Maillard, F., & Kelly, F. (1990). The quality of life of insomniacs questionnaire (QOLI). Medical Science Research, 18, 845–847.Google Scholar
  54. 54.
    Léger, D., Scheuermaier, K., Raffray, T., Metlaine, A., Choudat, D., & Guilleminault, C. (2005). HD-16: A new quality of life instrument specifically designed for insomnia. Sleep Medicine, 6, 191–198.CrossRefPubMedGoogle Scholar
  55. 55.
    Kyle, S. D., Crawford, M. R., Morgan, K., Spiegelhalder, K., Clark, A. A., & Espie, C. A. (2013). The Glasgow Sleep Impact Index (GSII): A novel patient-centred measure for assessing sleep-related quality of life impairment in Insomnia Disorder. Sleep Medicine, 14, 493–501.CrossRefPubMedGoogle Scholar
  56. 56.
    Morgan, K., Dixon, S., Mathers, N., Thompson, J., & Tomeny, M. (2003). Psychological treatment for insomnia in the management of long-term hypnotic drug use: A pragmatic randomised controlled trial. British Journal of General Practice, 53(497), 923–928.Google Scholar
  57. 57.
    Espie, C. A., MacMahon, K. M. A., Kelly, H.-L., Broomfield, N. M., Douglas, N. J., Engleman, H. M., et al. (2007). Randomized clinical effectiveness trial of nurse-administered small-group cognitive behavior therapy for persistent insomnia in general practice. Sleep, 30, 574–584.PubMedGoogle Scholar
  58. 58.
    Soeffing, J. P., Lichstein, K. L., Nau, S. D., McCrae, C. S., Wilson, N. M., Aguillard, R. N., et al. (2008). Psychological treatment of insomnia in hypnotic-dependant older adults. Sleep Medicine, 9, 165–171.CrossRefPubMedCentralPubMedGoogle Scholar
  59. 59.
    Morin, C. M., Koetter, U., Bastien, C. H., Ware, J. C., & Wooten, V. (2005). Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep, 28, 1465–1471.PubMedGoogle Scholar
  60. 60.
    McCall, W. V., Erman, M., Krystal, A. D., Rosenberg, R., Scharf, M. M., Zammit, G. K., et al. (2006). A polysomnography study of eszopiclone in elderly patients with insomnia. Current Medical Research and Opinion, 22, 1633–1642.CrossRefPubMedGoogle Scholar
  61. 61.
    Wagner, J., & Wagner, M. (2000). Non-benzodiazepines for the treatment of insomnia. Sleep Medicine Reviews, 4, 31.CrossRefGoogle Scholar
  62. 62.
    Gunja, N. (2013). The clinical and forensic toxicology of Z-drugs. Journal of Medical Toxicology, 9, 155–162.CrossRefPubMedCentralPubMedGoogle Scholar
  63. 63.
    Gunja, N. (2013). In the Zzz zone: The effects of Z-drugs on human performance and driving. Journal of Medical Toxicology, 9, 163–171.CrossRefPubMedCentralPubMedGoogle Scholar
  64. 64.
    Drug Safety and Availability—FDA Drug Safety Communication: Risk of next-morning impairment after use of insomnia drugs; FDA requires lower recommended doses for certain drugs containing zolpidem (Ambien, Ambien CR, Edluar, and Zolpimist). http://www.fda.gov/drugs/drugsafety/ucm334033.htm
  65. 65.
    Eisen, J., MacFarlane, J., & Shapiro, C. M. (1993). Psychotropic drugs and sleep. BMJ, 306, 1331–1334.CrossRefPubMedCentralPubMedGoogle Scholar
  66. 66.
    Roehrs, T., & Roth, T. (2010). Drug-related sleep stage changes: Functional significance and clinical relevance. Sleep Medicine Clinics, 5, 559–570.CrossRefPubMedCentralPubMedGoogle Scholar
  67. 67.
    Tobler, I., Kopp, C., Deboer, T., & Rudolph, U. (2001). Diazepam-induced changes in sleep: Role of the alpha 1 GABA(A) receptor subtype. Proceedings of the National Academic Science Unite States of America, 98, 6464–6469.CrossRefGoogle Scholar
  68. 68.
    Zisapel, N. (2007). Sleep and sleep disturbances: Biological basis and clinical implications. Cellular and Molecular Life Sciences, 64, 1174–1186.CrossRefPubMedGoogle Scholar
  69. 69.
    Johnson, A. E., & Sanchez, M. E. (1993). Household and medical provider reports on medical conditions: National medical expenditure survey, 1987. Journal of Economic and Social Measurement, 19, 199–223.Google Scholar
  70. 70.
    Zuvekas, S. H., & Olin, G. L. (2009) Validating household reports of health care use in the medical expenditure panel survey. Health Services Research, 44(5p1), 1679–1700.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.College of PharmacyThe University of Texas at AustinAustinUSA

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