Late-night clock watchers may have sweet dreams after all. New drugs as well as behavioral therapy may help the millions who suffer from insomnia.
“In 2005, there’s going to be a huge amount of noise regarding the treatment of insomnia,” said Dr. Phyllis Zee, director of the Sleep Disorders Center at Northwestern Memorial Hospital and a spokeswoman for the National Sleep Foundation. Several drugs are in the pipeline for FDA approval.
About 40 million Americans suffer from a chronic sleep disorder, according to the National Institutes of Health. An additional 20 million to 30 million have intermittent sleep-related problems. Women and the elderly suffer the most.
Insomnia can wreak havoc on work, personal relationships, mental activity and emotional state. “Insomnia is not just a nighttime problem,” Zee said. “It is a 24-hour problem, and it needs to be treated as such.”
Older sedative drugs like Halcion, known as a benzodiazepine, were good at inducing sleep but not at keeping people asleep. These drugs also may impair memory and leave people feeling groggy the next day. The next-generation sleep drugs, the popular Ambien and Sonata, were developed in the late 1980s to treat short-term insomnia. These non-benzodiazepines help people fall asleep, stay asleep and wake without drowsiness.
But many people have chronic insomnia, in which symptoms last a month or longer. Chronic insomnia may be caused by medical, physical or psychological conditions, another sleep disorder, or medications and substances.
In December, the FDA approved Lunesta, the first prescription sleep drug considered safe and effective for long-term use. Lunesta, another non-benzodiazepine, helps people fall asleep and stay asleep for six or seven hours. It also helps keep grogginess at bay.
Other sleep drugs awaiting FDA approval include Indiplon, with either an immediate release form or a timed release that helps to maintain sleep throughout the night; and Ramelteon, a new type of sleep medication that may promote sleep by helping to regulate the body’s 24-hour sleep-wake cycle.
More Top Picks Best Therapy Balls For Adhd Students
Behavioral therapy can be nearly as effective as drug therapy in treating insomnia, Zee said. But it takes time and effort to change attitudes and behavior toward sleep.
Unless people learn to manage their stress during the day, anything they do in the evening to combat insomnia is just a bandage, said Dr. Ramadevi Gourineni, a neurologist at Northwestern Memorial Hospital.
“People don’t spend time learning ways to relax during the day,” Gourineni said. “Insomnia is a nighttime frustration, but those with insomnia are more aroused during the day. Stress is not what keeps people up at night; it’s how we react to stress during the day.”
To reduce stress, she recommends relaxation through meditation and yoga. Meditation reduces heart rate and blood pressure and also changes how people perceive stress. It makes them calmer, she said.
Some people are genetically light sleepers, Gourineni said. Some are vulnerable to insomnia but sleep fine until a triggering event occurs, such as job or marital stress.
“I believe the nervous system explains why some are light sleepers and others aren’t,” said Dr. Thomas Freedom, director of the Sleep Disorders Centers at Evanston and Glenbrook Hospitals. A high level of arousability–physiologically, cognitively or emotionally–may predispose one to insomnia, Freedom said. People who are anxious, obsessive or who have high energy also may fall victim to the nighttime curse.
The choice of whether to use drugs or behavioral therapy depends on the cause and type of insomnia, Freedom said. For short-term insomnia, medications may be best. For long-term insomnia, behavioral therapy may be better, sometimes combined with medication.
Andy Simmons, 44, of Chicago has had trouble sleeping since childhood. “I would waken many times during the night,” said the manager of a sales consulting group for a software company. A sleep evaluation revealed he had periodic limb movements, or brief muscle contractions that cause leg jerks throughout the night. Simmons began drug treatment that “only helped a little.”
He tried different drug combinations fruitlessly until Zee concluded that Simmons’ natural circadian rhythm, or sleep-wake cycle, was pushed ahead–he needed to go to bed earlier and wake earlier.
Simmons now takes medication, practices bedtime relaxation techniques, turns in around 9:30 or 10 p.m. and wakes at 5 a.m. He feels better during the day, he said.
Some worry that sleep medication may be as addictive as late-night reruns. Patients can build tolerance to certain drugs if taken for long periods, meaning the drugs lose their effectiveness and must be taken at higher doses to produce an effect, Zee said.
“Newer drugs, such as Ambien and Sonata, are probably safe although indicated for short-term treatment,” Zee said.
However, long-term use of benzodiazepines could be associated with tolerance.
Early treatment can help prevent short-term insomnia from becoming chronic. The most important sleep tip is to maintain a regular sleep and wake pattern seven days a week.
Northwestern Memorial Hospital is conducting randomized, controlled studies to validate the effectiveness of behavioral approaches in treating insomnia in different age groups. Call 312-926-8400 for more info.