- The Washington Times - Thursday, June 16, 2005


Millions of Americans lie awake at night counting sheep — or have a stiff drink or pop an allergy pill, hoping it will make them drowsy.

But doctors and medical scholars agree that self-medicating is a bad idea, and the causes of chronic insomnia remain mysterious.

Almost a third of adults have trouble sleeping, and about 10 percent have symptoms of daytime impairment that signal true insomnia.

Sufferers readily cite the resulting problems: walking around in a fog, as memory and other cognitive functions slow; dozing off at the wheel or at work; depression; lack of energy.

But for all the complaints, scientists know surprisingly little about what causes chronic insomnia, its health consequences and how best to treat it, a panel of specialists brought together by the National Institutes of Health concluded yesterday.

Most, but not all, insomnia is thought to accompany other health problems, from arthritis and depression to cardiovascular disease. The question often is whether the insomnia came first or was a result of the other diseases — and how trouble sleeping in turn complicates those other problems.

“We know way too little about all those variables,” said panel chairman Alan Leshner, chief of the American Association for the Advancement of Science.

Two things are clear, the panel found: Chronic insomnia is a major public health problem, and too many people are using unproven therapies even while there are a few treatments that do work.

The hope is that the report will dispel some of what panelist Dr. Sean Caples of the Mayo Clinic decried as “misinformation and myths.”

Among the panel’s findings:

• Cognitive/behavioral therapy. This psychology-based treatment that trains people to reduce anxiety and take other sleep-promoting steps is effective, and doesn’t cause side effects, but it can be hard to find health care providers trained in the techniques. Insomniacs should check with board-certified sleep specialists and psychologists.

• Newer prescription sleep pills Sonata, Ambien and Lunesta work without many of the side-effect concerns of older agents known as benzodiazepines. One study of Lunesta showed effectiveness with six months of use, but more research on long-term use of all three is needed, as chronic insomnia can linger for years.

• The most commonly used treatments are alcohol and over-the-counter sedating antihistamines like Benadryl. Alcohol use actually disrupts quality sleep, and antihistamines can cause lingering daytime sedation and other cognitive problems.

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