Insomnia: treating a disease not a symptom

There has never been a better time to have a sleep disorder.

Awareness of clinical sleep disorders and clinical sleep medicine expertise is growing. We can see this in the increasing efforts to develop new treatments, and the expanding specialty training programs. We can also sense the growing importance of sleep because of intensified advertising on TV which encourages viewers to seek attention for sleep dissatisfaction – often for the first time. Americans today are both sleep-deprived and sleep-disordered.

There are many kinds of sleep disorders. Most of them you may not have come across in your reading. They include:

Parasomnias: behaviors coming out of sleep like sleep walking and sleep eating
Hypersomnias: conditions like obstructive sleep apnea and narcolepsy which are often characterized by excessive sleepiness in daytime
Movement disorders: while strictly disorders of wakefulness, they can impact sleep (Restless Leg Syndrome is perhaps the best known)

But insomnia remains the commonest sleep disorder affecting Americans and most likely to require sleep medications. More than 30% of Americans report sleep complaints, and of those, nearly half report chronic insomnia.

Patients often come to me at their wits' end for help with insomnia, fearful of becoming dependent on sleep medicines and often admitting that they have borrowed medicines from a family member in their desperation to sleep well. One of the first interventions I make is to tell these patients that there is indeed a healthy and safe place for supervised medications to help them sleep better. Quite honestly, the risks of not treating insomnia far outweigh the risks of sleep aids over the long term.

Sleep medicine is finally embracing a new philosophy to approaching patients: Insomnia is a chronic disorder that needs to be managed with careful and often long-term pharmacotherapy, among other treatments, rather than relegated as a troublesome symptom that needs to be palliated over the short term.

This decision to finally understand insomnia as a legitimate disorder and not a symptom was made in a National Institute of Health (NIH) State of the Science Panel in June 2005. This decision completely changed the practices and attitudes of many physicians to treating sleeplessness though certainly some colleagues do need to catch up with the new outlook. As a result of the NIH defining insomnia as a disease, drug companies could carefully test new sleep medicines over long-term use and find that they are in fact safe. This sea change has lead to newer FDA approvals for long-term prescriptions of the hypnotic class of sleep medications.

I tell my patients these changing attitudes contribute greatly to encouraging both patients and their doctors. Stigma over seeking treatment for insomnia continues to persist and certainly presents a major obstacle for finding the correct help. In the meantime, let's find out what's inside the medicine cabinet.