Managed care considerations

Managed care issues arising from excessive daytime sleepiness (EDS), which impacts as many as 37% of adults, are widespread. In the United States, insomnia is among the 3 most common complaints. Often it is younger people who have difficulty falling asleep, whereas their elders report more difficulty remaining asleep. Currently, people in the United States sleep 25% fewer hours than they did 100 years ago. Chronic sleep deprivation may be a choice driven by economic or social factors. Industrialized countries engage about 20% of the work force in shifts, and people working night shifts are thought to average 8 fewer hours of sleep each week than day workers. Falling asleep behind the wheel is the single most imminent risk associated with excessive sleepiness. Nonpharmacologic treatments for EDS include light variations, positive-airway pressure, dental and oral devices, and cognitive-behavioral therapy. When used, any pharmacologic treatment must carefully balance the amount of wakeful stimulation with bedtime drowsiness.