Medicalisation, pharmaceuticalisation, or both? Exploring the medical management of sleeplessness as insomnia

Abstract

In this paper we examine the medical management of sleeplessness as ‘insomnia’, through the eyes of general practitioners (GPs) and sleep experts in Britain. Three key themes were evident in the data. These related to (i) institutional issues around advocacy and training in sleep medicine (ii) conceptual issues in the diagnosis of insomnia (iii) and how these played out in terms of treatment issues. As a result, the bulk of medical management occurred at the primary rather than secondary care level. These issues are then reflected on in terms of the light they shed on relations between the medicalisation and the pharmaceuticalisation of sleeplessness as insomnia. Sleeplessness, we suggest, is only partially and problematically medicalised as insomnia to date at the conceptual, institutional and interactional levels owing to the foregoing factors. Much of this moreover, on closer inspection, is arguably better captured through recourse to pharmaceuticalisation, including countervailing moves and downward regulatory pressures which suggest a possible degree of depharmaceuticalisation in future, at least as far prescription hypnotics are concerned. Pharmaceuticalisation therefore, we conclude, has distinct analytical value in directing our attention, in this particular case, to important dynamics occurring within if not beyond the medicalisation of sleeplessness as insomnia.

“You have to do something”: Snoring, sleep interembodiment and the emergence of agency

“…Many people do try to manage sleep and sleepiness, but are met with limited success. Scholars have identified a number of strategies individuals use to regulate their sleep and manage sleep‐related problems, including “personalized strategies” such as having a warm drink or taking a shower before bed (Hislop & Arber, 2003b), medicalization via diagnoses or the use of various pharmaceuticals (Coveney, Williams, & Gabe, 2018; Moloney, 2017), and customization strategies such as workplace napping or the use of wakefulness‐promoting drugs (Williams, Coveney, & Gabe, 2013). Further, the growing expectation that individuals must successfully manage sleep‐related issues has facilitated the commodification of sleep, resulting in an expanding number of consumer products and services available for the enhancement of sleep (Barbee, Moloney, & Konrad, 2018; Mooallem, 2007).…”

Communicative and Discursive Perspectives on the Medication Experience

“…Are expert or lay words like ‘disease’, ‘illness’, ‘ailment’, and ‘complaint’ and for specifics like ‘sleeplessness’ and ‘sleep disorder’ associated with different terms for medications and taking medications, perhaps encoding different degrees of medicalization [ 51 ] or pharmaceuticalization. Thus, is someone who complains of ‘poor sleep’ rather than ‘sleep disorder’ or ‘insomnia’ [ 52 ] liable to speak of ‘taking something for it’ rather than ‘taking a pill’? (of course, the doctor’s own diagnosis may affect the patient’s own thinking).…”

The alternativisation of healthcare: A sociological framework for analysis

“…With pharmaceutisation, pharmaceutical companies are said to be manufacturing new diseases (Moynihan et al, 2002); defining non-medical problems as requiring pharmaceutical interventions; bypassing medical authority through over-the-counter drug sale and direct-to-consumer advertising; and engaging in the production of drugs beyond treatment purposes or for enhancement and lifestyle purposes to healthy people (Abraham, 2010;Gabe et al, 2015;Williams et al, 2017Williams et al, , 2011. The consequences of pharmaceutisation can be seen in the increasing upsurge of healthy people taking pharmaceutical drugs for the treatment of anxiety (Williams et al, 2011), cholesterol reduction (Will & Weiner, 2015), weight loss, sexual dysfunction (Fox et al, 2005), cognitive enhancement (C. M Coveney et al, 2011) and sleeplessness (C Coveney et al, 2019).…”