Consumption of sleeping pills in Taiwan has been increasing each year, with nearly one-fifth of the population taking about 1.5 billion pills last year, the Ministry of Health and Welfare said.
Insomnia is on the rise, with a survey of 600 people by the Taiwan Society of Sleep Medicine in 2019 indicating that 10.7 percent of daytime workers had insomnia, while the prevalence rate among shift workers was 23.3 percent.
The number of people who consumed sleeping pills grew from about 4.19 million in 2017 to about 4.41 million last year, while total consumption increased from about 880 million to 1.5 billion during the same period, National Health Insurance (NHI) data showed.
Photo: Chen Chien-chih, Taipei Times
NHI claims for sleeping pill prescriptions by healthcare facilities showed that 45 percent came from clinics, with psychiatry, family medicine and internal medicine departments being the three leading dispensers of the medication at 32 percent, 24 percent and 17 percent respectively.
The NHI system does not limit which medical departments can prescribe sleeping pills, but doctors cannot authorize more than one pill per day, said Chang Hui-ping (張惠萍), deputy head of the National Health Insurance Administration’s Medical Review and Pharmaceutical Benefits Division.
Prescribing sleeping pills for more than six straight months is also inadvisable, Chang said.
If a person needs to take sleeping pills for a longer period, the doctor should write down the reason in the patient’s medical record and the patient should be referred to a psychiatry department for further assessment, she added.
NHI claims by psychiatry clinics accounted for only about 20 percent of all sleeping pill prescriptions; the larger percentage — sometimes reaching more than 50 percent — came from non-psychiatry clinics, Chang said.
The percentage of cases with a sleeping pill prescription also increased from 4 percent to 19 percent in a year at some clinics.
The NHI has issued a notice to medical associations reminding them to tighten management of sleeping pill prescriptions, as some clinics prescribed nearly as many sleeping pills as psychiatry clinics, she said.
There have been reports of all members of one family or people working in the same office seeking treatment together and getting sleeping pills at the same time, she added.
Taiwan Association of Family Medicine president Huang Hsin-chang (黃信彰) said that as holistic healthcare has become a trend, doctors might be inclined to prescribe medicine according to a patient’s needs, which makes it more convenient for the patients and also saves NHI resources.
Many family doctors will first instruct their patients to practice non-pharmaceutical interventions, such as exercising, avoiding caffeine after 3pm, and finding ways to reduce mental stress, he said.
Taiwan Medical Association board member and Taiwan Society of Internal Medicine’s NHI policy committee member Wang Fong-yu (王宏育) said that many people have sleeping disorders because of stress, and the COVID-19 pandemic has added to their numbers.
As use of holistic health care and comprehensive outpatient clinics has been increasing, more doctors act more like family doctors, assessing each patient’s general condition, rather than advising them to seek a specialist if they have trouble sleeping, he said.
Asking people to seek further treatment by consulting different medical departments would also mean more diagnostic fees, he said.
Many medical associations have learning courses reminding physicians to prescribe medicine for sleeping disorders step by step, such as beginning with antihistamines, then muscle relaxants and anxiolytics, before prescribing sleeping pills, Wang said.
If any of the medication has a negative effect on the patient, they should refer the patient to a sleep specialist, Wang said.
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