Most drugs prescribed for chronic insomnia have not been approved for that purpose or studied for long-term use, reported a panel of scientists gathered at the National Institutes of Health last week. They said behavioral and cognitive therapies are often effective but underused.
Prevalence Chronic insomnia is marked by frequent difficulty falling sleep or waking too often or too early for at least 30 days. Untreated, the condition can affect social functioning and interfere with daily life. About 30 percent of adults deal with sleep disruption, and chronic insomnia is their most common complaint.
Treatments According to the panel, cognitive behavioral therapy (CBT) can be as effective as prescription drugs, without the danger of side effects. The treatment combines relaxation and talk therapy. But drugs remain the most popular treatment, the panel found. The most prescribed medication is the antidepressant Desyrel, which has not been approved by the Food and Drug Administration (FDA) for treatment of insomnia and whose long-term side effects are unknown, according to the panel.
Approved for insomnia are Ambien, Sonata and Lunesta, but they too "have short-term benefits, and the real gap is for long-term treatments," said Sean Caples, a panel member who practices sleep medicine at the Mayo Clinic in Rochester, Minn., in an interview. Over-the-counter antihistamines are also inappropriately used, the panel said.
Causes Insomnia is usually linked to stress, anxiety, consumption of caffeine or alcohol, and sometimes to medical conditions such as depression.
Diagnosis Self-reporting and a physical exam by a specialist is usually enough to diagnose the condition, but pills are not the first remedy for some physicians. James Yen, medical director of the National Capital Sleep Center at Suburban Hospital, starts with "sleep hygiene" lessons, including daily exercise, caffeine restrictions and a sleeping schedule. This works for 40 to 50 percent of patients; for others he prescribes mild drugs such as Ambien and then, if needed, antidepressants. "If none of this works," he said, "I'll refer them to a psychologist or psychiatrist."
Bottom Line Alan Leshner, panel chair, encouraged patients to ask for CBT before swallowing drugs. "We hope that the public will be more selective" with both over-the-counter and prescription medication, he said.
-- Naseem Sowti