Is a good night’s sleep worth $5,010?
According to a 2009 study, that’s the annual per-person cost of insomnia syndrome (in Quebec).
Of this, $4,717 is considered indirect cost, primarily loss of productivity, including job absenteeism. Only $293 is spent directly on health care and medication related to insomnia.
(see www.sciencedaily.com/releases/2009/01/090101083258.htm)
Although insomnia can be a difficult problem, when addressed systematically a solution can be found in nearly all cases. As a family physician, I see too many people who’ve given up after a single attempt at resolving the situation,
The answer is not necessarily drugs, although medication is often useful. Before resorting to pharmaceutical intervention, lifestyle interventions should be addressed. For a good review of ways to cure or improve insomnia without the use of drugs, check out this article: http://www.aafp.org/afp/2009/0115/p125.html. Some of the simplest advice includes avoiding all caffeine at least 8 hours before bedtime, avoiding stimulant medications (such as pseudoephedrine), exercising early in the day but not within 2 hours of going to sleep, and using your bedroom only for sleep.
If you do need medication, there are many to choose from. The first choice is often OTC sleep aids, which include a sedating antihistamine, usually diphenhydramine. Some people are kept awake by minor aches and pains, in which case OTC Tylenol or ibuprofen may help, alone or in combination with diphenhydramine.
Beyond this, prescription drugs are useful. The newest are always the most expensive. Tricyclic antidepressants are often effective (e.g. Elavil) and cost only a few dollars a month. Ambien is a popular choice, but at $190 a month you might prefer generic (zolpidem) for under $20. Generic benzodiazapine medications (Restoril, Xanax, Ativan, Valium, and others) are effective and inexpensive, but are indicated for short-term use only.
Of course, it’s best not to take a sleep aid every night – the body tends to become reliant (if not addicted) when these are used regularly. The behavioral interventions should also be used in essentially every patient who requires medication.
Rozerem acts similarly to melatonin, the natural human sleep-inducing chemical. It was developed to help mimic natural sleep cycles and avoid the concerns of sedative addiction. It, too, is expensive (over $150/month) but very useful in certain patients.
What about a glass of wine? I’m not generally one to recommend alcohol, but it’s true that patients who consume one glass of red wine daily have a slight edge over those who don’t, at least in the area of cardiovascular health. If you have no other health concerns (alcoholism, gastritis, GERD, liver disease, medication interactions, etc.), then a glass of red wine near bedtime may help you sleep.
I value my sleep and try to make sure I get a good 7 hours daily. I take my own advice and avoid caffeine after 3 p.m. Sometimes I take Tylenol, especially if the sciatica is acting up. If I have a bad cold, Nyquil works wonders. My kids are much happier if I sleep enough. Residency nearly killed me, what with staying up nearly all night, twice a week.
Cost savings to America if only 1,000 people had their insomnia resolved using the above suggestions:
$5010/year x 1,000 patients = $5,010,000 annually (a gross underestimate of possible savings)
© Cynthia J Koelker, MD – All rights reserved
http://www.101waystosavemoneyonhealthcare.com/
