Even though insomnia is the most common sleep disorder, it is often left unrecognized and untreated, despite advances in diagnosis and management. The risk of developing other illnesses, such as diabetes, depression, hypertension, and possibly even death in older adults increases if insomnia is left untreated. A review published Online First in The Lancet concludes that to ensure that patients are treated according to clinical guidelines, rather than being administered with off-label drugs that show little evidence in terms of effectiveness, more needs to be done to diagnose and treat insomnia early.
Authors of the Seminar, Charles Morin from the Université Laval in Québec City, Canada and Ruth Benca from the University of Wisconsin in Madison, USA, declare:
“In view of the high prevalence and substantial morbidities of insomnia, patients should routinely be asked about sleep problems by health-care providers.”
It is estimated that about a quarter of the adult population suffer from sleeping problems, with an estimated 6 to 10% suffering from insomnia, which is characterized by experiencing difficulty in falling or staying asleep, lacking restorative sleep and daytime symptoms, such as having trouble to concentrate, being fatigued and suffering from mood swings.
Most insomnia sufferers are prone to recurrent episodes and according to longitudinal research, almost 70% of insomnia sufferers continue to experience symptoms a year later, whilst half still experience insomnia up to 3 years later.
Individuals with insomnia suffer from various increased health risks, such as being over five times more likely to experience anxiety and depression, they have a more than double the risk of developing congestive heart failure and diabetes, and have an elevated risk of death. According to one study, those suffering from insomnia have a seven times higher risk of alcohol or drug abuse over the next three and a half years, than those without the condition.
The authors found that insomnia also creates a significant economic and societal burden due to poor productivity, absence from work, and high health-care costs. They note that long term use of over-the-counter and prescription drugs remains insufficiently researched despite its widespread use and that there is little evidence of which drugs work best and for whom.
Furthermore, they point out that some of the most commonly prescribed drugs, such as antidepressants and antihistamines, have not yet been approved for the treatment of insomnia and declare that more research is urgently required to evaluate the efficacy of individual drugs for treating insomnia.
In light of the findings, the National Institutes of Health in the USA declared that only two treatment options, i.e. cognitive behavioral therapy [CBT] and approved hypnotic drugs have shown sufficient evidence to support their use for treating insomnia.
CBT, a therapy using psychological and behavioral methods, such as relaxation techniques, sleep restriction, stimulus control, and education about sleep hygiene like diet, exercise, and the bedroom environment, has proven highly effective at treating insomnia. It has no risks of adverse side effects and provides long-lasting benefits, a clear advantage compared with drug treatment, however, at the moment there is a shortage of health-care professionals trained in CBT.
The authors conclude:
“Although CBT is not readily available in most clinical settings, access and delivery can be made easier through the use of innovative methods such as telephone consultations, group therapy, and self-help approaches via the internet. There is an urgent need for more public education about sleep and broader dissemination of evidence-based therapies for insomnia, and education and training to prepare health-practitioners to attend and treat insomnia complaints according to clinical guidelines.”
Written by Petra Rattue