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. 2019 Mar;27(3):301-309.
doi: 10.1016/j.jagp.2018.10.017. Epub 2018 Nov 2.

Trends in Insomnia Diagnosis and Treatment Among Medicare Beneficiaries, 2006-2013

Jennifer S Albrecht  1 , Emerson M Wickwire  2 , Aparna Vadlamani  3 , Steven M Scharf  4 , Sarah E Tom  5
Affiliations

Trends in Insomnia Diagnosis and Treatment Among Medicare Beneficiaries, 2006-2013

Jennifer S Albrecht et al. Am J Geriatr Psychiatry. 2019 Mar.

Abstract

Objective: Insomnia is an important clinical problem affecting the elderly. We examined trends in insomnia diagnosis and treatment among Medicare beneficiaries over an eight-year period.

Methods: This was a time-series analysis of Medicare administrative data for years 2006-2013. Insomnia was defined as the presence of at least one claim containing International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 307.41, 307.42, 307.49, 327.00, 327.01, 327.09, 780.52, or V69.4 in any given year. Insomnia medications were identified by searching the Part D prescription drug files in each year for barbiturates, benzodiazepines, chloral hydrate, hydroxyzine, nonbenzodiazepine sedative hypnotics, and sedating antidepressants.

Results: Prevalence of physician-assigned insomnia diagnoses increased from 3.9% in 2006 to 6.2% in 2013. Prevalence of any insomnia medication use ranged from 21.0% in 2006 to 29.6% in 2013 but remained steady. A sharp increase in use of benzodiazepines from 2012-2013 (1.1% to 17.6%) drove up total insomnia medication use for 2013. Prevalence of both insomnia diagnosis and medication use ranged from 3.5% in 2006 to 5.5% in 2013, while prevalence of either insomnia diagnosis or medication use ranged from 22.7% in 2006 to 31.0% in 2013.

Conclusion: In this large national analysis of Medicare beneficiaries, prevalence of physician-assigned insomnia diagnoses was low but increased over time. Prevalence of insomnia medication use was up to four-times higher than insomnia diagnoses and remained steady over time. Notably, prevalence of benzodiazepine use increased dramatically from 2012-2013 after these medications were included in the Medicare Part D formulary.

Keywords: Insomnia; Medicare; insomnia medication; older adults.

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Conflict of interest statement

Conflicts of Interest

No other conflicts of interests are declared. Results from this study were presented at SLEEP, June 2018, Baltimore, MD.

Figures

Figure 1.
Figure 1.
Annual prevalence of insomnia diagnosis, by International Classification of Disease code, medication use, either, or both, 2006–2013
Figure 2.
Figure 2.
Annual prevalence of insomnia medication use, 2006–2013
Figure 3.
Figure 3.
Annual prevalence of insomnia diagnosis, by International Classification of Disease code, medication use, either, or both, by sex, 2006–2013
Figure 4.
Figure 4.
Annual prevalence of insomnia medication use by sex, 2006–2013
See this image and copyright information in PMC

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