Selling slumber: American neoliberalism and the medicalization of sleeplessness

Abstract

Sleeplessness is an ancient and cross‐cultural phenomenon that is socially structured and restructured against a backdrop of ideology and inequality. In an effort to make sense of sleeplessness, some scholars have invoked the medicalization framework, which highlights consumerism, managed care, biotechnology, and physicians as key “engines” that foster the transformation of this formerly “normal” condition to one that people view as a medical problem. However, this burgeoning literature has not answered the call of medical sociologists to situate the medicalization process in a political economic context. In this article, we employ the case study of sleeplessness and the creation of the “Sleep Industrial Complex” to expand the medicalization framework and illustrate how American neoliberalism creates an ideal environment for the primary engines of medicalization. We identify three critical features of American neoliberalism—enhancement culture, commodification of health, and a “productivity imperative”—that act in concert with the driving engines to foster an environment wherein medicalization not only survives but also thrives.

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

“…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).…”

The medicalization of sleeplessness: Results of U.S. office visit outcomes, 2008–2015

“…Changes in DTCA may also impact prescription rates. As recently described by Barbee and colleagues (Barbee et al, 2018), DTCA for NBSH has fallen off steeply in recent years 3. For context, makers of Ambien and Ambien CR, the most popular of the newer-generation sedative-hypnotics spent $147 million on DTCA in 2008, a time of economic recessesion (Weinstein, 2013).…”

“…Quantitative and qualitative research has identified multiple social and behavioral factors (e.g., career uncertainty, near-constant use of light-producing technology, worry over children or aging parents) that are closely linked to sleep loss and request for sleep aids (Moloney, 2017; Seidel, Yorgason, Polenick, Zarit, & Fingerman, 2017; Thomee, Harenstam, & Hagberg, 2011). Additional factors, particularly relevant to the United States and its aging, Baby Boom generation, that fuel the multi-billion dollar “Sleep-Industrial Complex” include: enhancement culture (self-transformation through techno-science), commodification of health (creation of niche health-services and products), and a “productivity imperative” (maximizing productivity in a 24/7 work culture) (Barbee et al, 2018). Future research could specifically investigate the extent to which these and other factors contribute to changing attitudes and practices related to sedative-hypnotics.…”

“…The factors that influence the medicalization process evolve over time. Currently, the primary engines of medicalization are: consumerism (patients challenge medical authority, seek physician compliance), managed care (medical encounter cost-controls), biotechnology (genetics, pharmaceuticals, and direct-to-consumer advertising), and physicians (gatekeepers to treatment) (Barbee, Moloney, & Konrad, 2018; Conrad and Cockerham, 2013; Moloney, 2017). Further, as medicine's cultural and structural contexts continually evolve, scholars have proposed new medicalization-related frameworks including biomedicalization (emphasizes the role of biomedicine and technology in illness and risk assessment) (Clarke et al, 2011), healthicization (individuals are responsible for controlling their health through personal strategies and/or commercially available products) (Hislop & Arber, 2003), and pharmaceuticalization (emphasizes pharmaceutical drugs as solutions to medicalized conditions) (Williams, Seale, Boden, Lowe, & Steinberg, 2008).…”

Determinants of Sleep Medication Use among Participants in the National Alzheimer’s Coordinating Center Uniform Data Set

“…Sufficient sleep is critical for health and well-being in older adults (Grandner, 2019), yet 20% to 30% of this population meet the diagnostic criteria for chronic insomnia (Neikrug & Ancoli-Israel, 2010). Increased awareness of sleep's importance to health has coincided with the development, promotion, and increased prescription of sleep medications (Barbee et al, 2018;Bertisch et al, 2014;Grandner, 2019;Mooallem, 2007). Between 1993 and 2007, rates of sleep medication prescriptions increased 30-fold in the United States (U.S.) (Moloney et al, 2011).…”