A recent consensus panel was convened at NIH to discusses the specific challenges facing insomnia research and recommended a variety of studies to help clarify the disorder's underlying mechanisms, natural history, the interaction between insomnia and other conditions, and the comparative risks and benefits of various therapies. The panel released its findings last week, following two days of expert presentations and panel deliberations.
Insomnia is the most common sleep complaint reported by women and men across all stages of adulthood, and for many, the problem is not episodic but chronic. Insomnia is both a symptom of certain conditions as well as a disorder with complex and, likely, multiple causes. Chronic insomnia is associated with a wide range of adverse effects, including depression; alcohol and drug abuse; difficulties with concentration and memory; and various cardiovascular, pulmonary, and gastrointestinal disorders.
The panel expressed concern that many of the drugs now used to treat insomnia, such as antidepressants and antihistamines, have not been approved for this indication and their efficacy in treating chronic insomnia has not been proven. Even those medications that have been approved for insomnia are approved only for short-term use, leaving chronic sufferers with few proven options. The panel noted that newer benzodiazepine receptor agonist medications have been developed that have fewer and less severe adverse effects than other medications, and show promise for long-term use, but this requires further evaluation. The panel also expressed concern that many insomnia sufferers self-medicate with alcohol, despite the numerous risks involved and the clear evidence that alcohol actually has a negative overall effect on the quality of sleep.
Interestingly, there is a body of research that indicates that behavioral methods such as relaxation training can be effective to treat insomnia when combined with cognitive therapies specifically targeted at anxiety-producing beliefs and erroneous beliefs about sleep and sleep loss. Moreover, this approach is unlikely to carry adverse side effects, and its benefits may be longer lasting than pharmacological interventions. The down-side to this intervention is that there are few practitioners trained in these therapies.
The live webcast was sponsored by the Office of Medical Applications of Research (OMAR) and the National Institute of Mental Health. Cosponsors included the National Center for Complementary and Alternative Medicine, the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, the National Institute of Nursing Research, the National Institute on Aging, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the Office of Research on Women's Health, and the U.S. Food and Drug Administration.