Putting tired ideas about insomnia treatment to bed

Have you ever struggled to fall asleep? Stay asleep? Or, wake up earlier than you wanted or needed to? Insomnia is more than just a disruption of our sleep routines or the occasional sleepless night. Insomnia can impact all aspects of our lives, including social, economic and health care costs that total in the billions of dollars every year.

Treatment for insomnia is readily available. Options include over-the-counter (OTC) treatments, sleep hygiene approaches (going to bed at the same time each day), cognitive behavioral therapy and common prescription treatments, such as Ambien.

Shortly after a new treatment was launched into this busy marketplace, a life sciences company engaged Optum to better understand how its treatment was being used.

The client had the following questions: 

• Which clinicians were prescribing the new medication and how were they identifying patients they felt would benefit from it?
• How do patients choose a medication to treat their sleep symptoms and when to use it?
• How has insomnia impacted patients’ lives in ways that can only be measured by interacting directly with patients?

To answer these questions, Optum’s health economics and outcomes research (HEOR) team conducted a two-part study that included the voices of patients with insomnia and the providers who treat them. 

First, Optum invited 200 providers from different specialties who were treating patients for insomnia to complete an online survey. The survey gathered information about first-line treatments for insomnia, symptom relief by treatment, satisfaction and titration patterns.

This showed:

• Specialists were more likely to prescribe the new therapy and had a different titration pattern compared with non-specialist providers.
• Although prescribers reported that their patients experienced treatment-related improvements, the high prevalence of treatment failure suggested patients stood to benefit from therapies with an improved safety profile.

Next, Optum used administrative claims data to outreach directly to patients using the new medication as well as other common prescription treatments. Information about these users, such as age and other characteristics, was compared with patients who were using standard of care treatments.

Optum utilized a rolling recruitment strategy to identify and invite 1,813 patients with current insomnia prescriptions to participate in a mailed survey study. A total of 592 patients returned the survey — more than 400 of whom described use of the medications of interest.

The results were enlightening:

• Desperate for sleep, patients will often use more than one sleep treatment per night or differing sleep treatments over the course of a week.
• Over-the-counter sleep treatments, something not easily observed in large administrative databases, are commonly used with prescription medications.
• The study found very interesting differences between younger and older patients with insomnia, highlighting the challenges that older patients (those older than age 65) have getting restful and restorative sleep.
• Patients with prescriptions for the new treatment seemed to have more medical conditions likely to contribute to poor sleep.

This study enhances patient, provider and life sciences insight into effective treatments for insomnia, especially for older patients. Older adults are a growing population with a tremendous impact on the global economy but are often neglected from studies where the impact is often thought of as only among a “working” population.

The results of this study demonstrate the potential to transform health care by helping patients of all ages sleep better and live healthier lives.