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.
Highlights
In this paper we examine the medical management of sleeplessness as ‘insomnia’ in Britain through the eyes of general practitioners (GPs) and sleep experts
In the data extract below, one of the sleep experts we interviewed talks about the lack of provision of sleep medicine services in the UK, contrasting this to the US where sleep medicine is more established as a speciality
As far as the first question goes, the sleep experts and GPs in our study discussed a number of problems with the management of sleeplessness, including what we have termed issues of an ‘institutional’, ‘conceptual’ and ‘treatment’ kind
Summary
In this paper we examine the medical management of sleeplessness as ‘insomnia’ in Britain through the eyes of general practitioners (GPs) and sleep experts. Recent strands of work within the sociology of sleep have sought to explore how ‘insomnia’ or ‘poor sleep’ is managed in every day/night life, far away from the doctor’s surgery or the sleep clinic (Venn and Arber 2012, Venn et al 2013) Across these studies, poor sleep was often regarded as a normal or inevitable consequence of daily life and people tended to express negative beliefs about sleeping pills and their effects, thereby providing grounds to ‘resist’ medicalisation and pharmaceuticalisation of their sleep. We arrive at the following research questions which we seek to answer in the remainder of this paper, regarding sleeplessness in general and sleeplessness as insomnia in particular:
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