Medications are not the only option for insomnia and anxiety, nor should they be

Certain medications such as benzodiazepines and other hypnotics are never indicated as first-line treatments for insomnia and anxiety, but an alarming number of patients are being treated with these medications as the first and only treatment intervention.

Big Health recently engaged Milliman to conduct a study on treatment patterns for traditional Medicare beneficiaries with insomnia disorder and generalized anxiety disorder (GAD) in the United States to determine how closely they aligned with guideline-recommended care.

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Key report findings1

  • Roughly a quarter (25%) of all patients with insomnia and GAD went untreated, and black patients with GAD went untreated at a higher rate (35%)
  • In 2020, 37% of beneficiaries taking non-hypnotic benzodiazepines were low-income compared to 30% for the total Medicare population.
  • Counter to FDA labeling guidance for hypnotic benzodiazepines and hypnotic Z-drugs to not exceed 30 days, 76% of beneficiaries under 65 filled hypnotic benzodiazepine prescriptions and 81% of beneficiaries under 65 filled prescriptions for hypnotic Z-drugs that exceeded that guidance.2

What this means for your workforce

The unfortunate reality is that many working employees may also be inappropriately prescribed or over prescribed benzodiazepines and hypnotics for insomnia and anxiety. These medications can drastically affect performance and safety in the workplace. Research has shown that employees struggling with insomnia have a 7x greater risk of being involved in industrial accidents in the workplace, which can lead to lost productivity costs for employers. And, if your employees are not being treated at all, they could seek maladaptive behaviors to help them cope with their mental health conditions, such as alcohol and substance use.

An alternative solution for employees

The guideline-recommended care for insomnia and anxiety is cognitive behavioral therapy (CBT), traditionally delivered through in-person therapy. However, today’s landscape of high demand for services and short supply of therapists makes it impossible to scale traditional care. Big Health harnesses the power of CBT in a unique digital experience that enables access to care for your entire population. Sleepio for insomnia disorder and Daylight for GAD are digital, non-drug treatments that have been rigorously tested and proven to be safe and effective. They can be easily implemented, delivered on a virtually limitless scale, and used in conjunction with other treatments.

Sleepio and Daylight are available as an adjunct to usual medical care for insomnia disorder or generalized anxiety disorder, respectively, for adults ages 18 and older, without FDA review under their COVID-19 policy.

  1. Bazell et al. (2022). Treatment Patterns for Generalized Anxiety Disorder and Insomnia in Medicare Fee-for-Service. White paper.
  2. Medicare beneficiaries under 65 are eligible for Medicare due to their disability or end stage renal disease status.
  3. Leger et al. (2002). Sleep
  4. Espie et al. (2012). Sleep; Carl et al. (2020). Depression and anxiety

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During the COVID-19 public health emergency, Sleepio and Daylight are being made available as treatments for insomnia disorder and generalized anxiety disorder (GAD), respectively, without a prescription. Sleepio and Daylight have not been cleared by the U.S. Food and Drug Administration (FDA) for the treatment of insomnia disorder and GAD, respectively.

1. Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125-133.2. Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., … & Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research, 26(6), 675-700.3. Wilson, S., Anderson, K., Baldwin, D., Dijk, D. J., Espie, A., Espie, C., … & Sharpley, A. (2019). British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: an update. Journal of Psychopharmacology, 33(8), 923-947.4. King’s Technology Evaluation Centre. (2017, November 9). Overview: Health app: SLEEPIO for adults with poor Sleep: Advice. NICE. https://www.nice.org.uk/advice/mib129.5. Espie, C. A., Kyle, S. D., Williams, C., Ong, J. C., Douglas, N. J., Hames, P., & Brown, J. S. (2012). A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep, 35(6), 769-781.6. Carl, J. R., Miller, C. B., Henry, A. L., Davis, M. L., Stott, R., Smits, J. A., … & Espie, C. A. (2020). Efficacy of digital cognitive behavioral therapy for moderate‐to‐severe symptoms of generalized anxiety disorder: A randomized controlled trial. Depression and Anxiety, 37(12), 1168-1178.

DOC-3046 Effective 11/2023