Clinical Drug Investigation

, Volume 18, Issue 2, pp 161–167 | Cite as

Psychiatric Comorbidity and Pharmacological Treatment Patterns among Patients Presenting with Insomnia

An Assessment of Office-Based Encounters in the USA in 1995 and 1996
  • Tracy L. SkaerEmail author
  • Linda M. Robison
  • David A. Sclar
  • Richard S. Galin


Background: Epidemiological studies reveal that approximately one-third of the US adult population experiences insomnia, and that nearly 10% report it to be a serious or chronic problem. Little is known as to the extent of physician diagnosis of the underlying illness, or the prescribing of pharmacotherapy for this complaint.

Objectives: To discern among US ambulatory patients presenting with insomnia as either the primary complaint, or as one of several reasons for requesting a physician-patient office-based encounter (visit), the percentage of said encounters wherein: (i) a diagnosis of insomnia was recorded [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 307.41, 307.42, 307.49, 780.50, 780.52, 780.55, 780.56, 780.59]; (ii) a diagnosis of a concomitant mental disorder (non-sleep-related) was recorded (ICD-9-CM codes 290-307.39, 307.5-319); (iii) a diagnosis of a depressive illness was recorded (ICD-9-CM codes 296.2-296.36, 300.4, 311); (iv) a regimen of a hypnosedative was continued or prescribed [National Drug Code (NDC) 0626]; (v) a regimen of antidepressant pharmacotherapy was continued or prescribed (NDC 0630); and (vi) a diagnosis of depression was recorded and a regimen of antidepressant pharmacotherapy was continued or prescribed.

Methods: Data from the National Ambulatory Medical Care Survey for the years 1995 and 1996, for adults aged 18 years or older, were utilised for this analysis.

Results: In the time-frame 1995 to 1996, an annualised mean of 3 027 312 patients presented with a complaint of insomnia as one of three reasons recorded for requesting an office-based visit. Insomnia was the primary reason for an office-based visit in 35.1% (1 061 396) of these patients. The majority of these patients were female (55.6%), White (66.2%), and had a mean age of 53.2 years (±16.8 years). Compared with patients presenting with insomnia as one of three reasons for the visit, a higher proportion of patients presenting with insomnia as the primary reason for the visit were diagnosed with insomnia (18.8%), diagnosed with a non-sleep-related mental disorder (57.4%), diagnosed with depression (31.7%), prescribed or continuing a regimen of hypnosedative pharmacotherapy (16.1%), prescribed or continuing a regimen of antidepressant pharmacotherapy (48.3%), or diagnosed with depression and prescribed or continuing a regimen of antidepressant pharmacotherapy (27.8%). Only 15.8% of the reporting physicians were psychiatric specialists.

Conclusions: Our findings indicate that fewer than 5% of US adults with insomnia reported visiting a physician specifically for this problem. The results suggest that insomnia is multifactorial in origin, with the majority of patients having been diagnosed with a non-sleep-related mental disorder, primarily depression.


Adis International Limited Clin Drug Invest Trimipramine National Ambulatory Medical Care Survey General Population Study 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 1989; 262: 1479–84CrossRefGoogle Scholar
  2. 2.
    Quera-Salva MA, Orluc A, Goldenberg F, et al. Insomnia and use of hypnotics: study of a French population. Sleep 1991; 14: 386–91PubMedGoogle Scholar
  3. 3.
    Katz DA, McHorney CA. Clinical correlates of insomnia in patients with chronic illness. Arch Intern Med 1998; 158: 1099–107PubMedCrossRefGoogle Scholar
  4. 4.
    Soldatos CR. Insomnia in relation to depression and anxiety: epidemiologic considerations. J Psychosom Res 1994; 38Suppl. 1: 3–8PubMedCrossRefGoogle Scholar
  5. 5.
    Ohayon MM. Prevalence of DSM-IV diagnostic criteria of insomnia: distinguishing insomnia related to mental disorders from sleep disorders. J Psychiatr Res 1997; 31: 333–46PubMedCrossRefGoogle Scholar
  6. 6.
    Schramm E, Hohagen F, Kappler C, et al. Mental comorbidity of chronic insomnia in general practice attenders using DSM-III-R. Acta Psychiatr Scand 1995; 91: 10–7PubMedCrossRefGoogle Scholar
  7. 7.
    Simon GE, VonKorff M. Prevalence, burden, and treatment of insomnia in primary care. Am J Psychiatry 1997; 154: 1417–23PubMedGoogle Scholar
  8. 8.
    National Sleep Foundation. 1998 Omnibus Sleep in America Poll, [accessed 1999 Jul 12]
  9. 9.
    Ohayon MM, Caulet M, Lemoine P. Comorbidity of mental and insomnia disorders in the general population. Compr Psychiatry 1998; 39: 185–97PubMedCrossRefGoogle Scholar
  10. 10.
    Eaton WE, Badawi M, Melton B. Prodromes and precursors: epidemiologic data for primary prevention of disorders with slow onset. Am J Psychiatry 1995; 152: 967–72PubMedGoogle Scholar
  11. 11.
    Kupfer DJ, Reynolds CF. Management of insomnia. N Engl J Med 1997; 336: 341–6PubMedCrossRefGoogle Scholar
  12. 12.
    Weissman MM, Greenwald S, Nino-Murcia G, et al. The morbidity of insomnia uncomplicated by psychiatric disorders. Gen Hosp Psychiatry 1997; 19: 245–50PubMedCrossRefGoogle Scholar
  13. 13.
    Radecki SE, Brunton SA. Management of insomnia in office-based practice. Arch Fam Med 1993; 2: 1129–34PubMedCrossRefGoogle Scholar
  14. 14.
    Woodwell DA. National Ambulatory Medical Care Survey, 1995 summary. Advance Data from Vital and Health Statistics. No. 286. Hyattsville, MD: National Center for Health Statistics, 1997Google Scholar
  15. 15.
    Woodwell DA. National Ambulatory Medical Care Survey, 1996 summary. Advance Data from Vital and Health Statistics. No. 295. Hyattsville, MD: National Center for Health Statistics, 1997Google Scholar
  16. 16.
    Bryant E, Shimizu I. Sampling design, sampling variance, and estimation procedures for the National Ambulatory Medical Care Survey. National Center for Health Statistics, Vital Health Stat 1988; 2: 1–39Google Scholar
  17. 17.
    Schneider D, Appleton L, McLemore T. Areason for visit classification for ambulatory care. National Center for Health Statistics. Vital Health Stat 1979; 2: 1–63Google Scholar
  18. 18.
    Instruction Manual: Reason for Visit Classification and Coding Manual, 1994. National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Hyattsville, MD: National Center for Health Statistics, 1995Google Scholar
  19. 19.
    US Public Health Service and Health Care Financing Administration. The International Classification of Diseases. 9th revision. Clinical Modification, Volume 1. DHHS Publication No. (PHS) 89-1260. Washington: Public Health Service, March 1989Google Scholar
  20. 20.
    Food and Drug Administration. National Drug Code Directory. 1995 ed. Washington: Public Health Service, 1995Google Scholar
  21. 21.
    Koch H, Campbell W The collection and processing of drug information. National Ambulatory Medical Care Survey, 1980. National Center for Health Statistics, Vital Health Stat 1982; 2: 1–90Google Scholar
  22. 22.
    SETS. Statistical Export and Tabulation System 1.22a: Users Reference Manual. United States Department of Health and Human Services, National Center for Health Statistics, 1991Google Scholar
  23. 23.
    Nino-Murcia G. Diagnosis and treatment of insomnia and risks associated with lack of treatment. J Clin Psychiatry 1992; 53 Suppl.: 43–7PubMedGoogle Scholar
  24. 24.
    The Gallup Organization. Sleep in America: a National Survey of US Adults. Los Angeles, CA: National Sleep Foundation, 1991Google Scholar
  25. 25.
    Silva J, Chase M, Sartorius N, et al. Special report from a symposium held by the World Health Organization and the World Federation of Sleep Research Societies: an overview of insomnias and related disorders — recognition, epidemiology, and rational management. Sleep 1996; 19: 412–6Google Scholar
  26. 26.
    US Census Bureau. National population estimates for the 1990s. Monthly postcensal resident population, by single year of age, sex, race, and Hispanic origin. Published 1998 Feb 22 [accessed 1999 Jul 12]
  27. 27.
    Hartmann PM. Drug treatment of insomnia: indications and newer agents. Am Fam Physician 1995; 51: 191–4PubMedGoogle Scholar
  28. 28.
    Ware JC, Morewitz J. Diagnosis and treatment of insomnia and depression. J Clin Psychiatry 1991; 52 Suppl.: 55–61PubMedGoogle Scholar
  29. 29.
    Gillin JC. Are sleep disturbances risk factors for anxiety, depressive and addictive disorders? Acta Psychiatr Scand 1998; 393 Suppl.: 39–43CrossRefGoogle Scholar
  30. 30.
    Foley DJ, Monjan AA, Brown SL, et al. Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 1995; 18: 425–32PubMedGoogle Scholar
  31. 31.
    Mellinger GD, Balter MB, Uhlenhuth EH. Insomnia and its treatment. Prevalence and correlates. Arch Gen Psychiatry 1985; 42: 225–32PubMedCrossRefGoogle Scholar
  32. 32.
    Ohayon MM. DSM-IV and ICSD-90 insomnia symptoms and sleep dissatisfaction. Br J Psychiatry 1997; 171: 382–8PubMedCrossRefGoogle Scholar
  33. 33.
    Hatoum HT, Kong SX, Kania CM, et al. Insomnia, health-related quality of life, and healthcare resource consumption: a study of managed care organization enrollees. Pharmacoeconomics 1998; 14: 629–37PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1999

Authors and Affiliations

  • Tracy L. Skaer
    • 1
    • 2
    Email author
  • Linda M. Robison
    • 1
  • David A. Sclar
    • 1
    • 3
    • 4
  • Richard S. Galin
    • 1
    • 2
    • 5
  1. 1.Pharmacoeconomics and Pharmacoepidemiology Research UnitCollege of Pharmacy, Washington State UniversityPullmanUSA
  2. 2.Pullman Memorial HospitalPullmanUSA
  3. 3.Program in StatisticsWashington State UniversityPullmanUSA
  4. 4.Washington Institute for Mental Illness Research and Training, Eastern BranchSpokaneUSA
  5. 5.Neuro-Psychiatric InstituteUniversity of California at Los AngelesLos AngelesUSA

Personalised recommendations