Insomnia

Insomnia is a very prevalent and expensive disorder.

The National Institute of Health estimates that insomnia affects more than 70 million Americans at a cost of about $14 billion annually. This figure reflects direct costs of treatment, healthcare services, hospital costs, and nursing home care costs. Indirect costs such as work loss, property damage from accidents, and transportation to and from healthcare providers are estimated to be about $28 billion.

Insomnia is defined as difficulty going to sleep, difficulty staying asleep, and/or waking up too early. Acute insomnia is often due to a temporary stressful event, usually lasts less than 3-4 weeks, and may be treated with sleeping medications. Chronic insomnia, which lasts a month or longer, may be primary or secondary to other medical, physical, or psychological conditions. Other sleep disorders such as snoring, Sleep Apnea, Restless Leg Syndrome, and Periodic Limb Movement Disorder are also major causes of secondary insomnia.

 

The appropriate diagnosis ensures the right treatment.

Insomnia is a risk factor for many other psychiatric and medical conditions and can significantly affect one's quality of life. Untreated insomnia can result in daytime fatigue, drowsy driving, mood disturbances, depression, and concentration difficulty. Poor sleep habits can be major contributing factors to insomnia.

 

Non-pharmacological treatment of Insomnia.

The non-pharmacologic treatments of insomnia typically include a combination of treatment methods, including:

• Improving sleep hygiene, which allows the patient to learn and implement techniques to help improve sleep;
• Stimulus control, which trains people to use their bed and bedroom for sleep and sex only and to avoid using it as a place for all other life activities;
• Relaxation techniques, which often involves reducing tension and muscular relaxation methods.
• Sleep Restriction, which involves decreasing time in bed to improve sleep efficiency.
• Cognitive Behavioral Therapy (CBT), which helps the patient with attitudes and beliefs that may contribute to poor sleep
• Timed light therapy

Cognitive Behavioral Therapy (CBT) is a method recommended by the American Academy of Sleep Medicine as a first line treatment option for insomnia. It involves the sleep specialist assisting patients in the identification of negative thoughts and associations related to sleep. With the assistance of a sleep specialist, patients overcome misperceptions about sleep and adopt new thoughts and associations to sleep. By combining CBT with other lifestyle modifications such as relaxation techniques, stimulus control, sleep restriction, and improved sleep hygiene, one can often overcome insomnia without pharmacological means.

Online programs offering CBT for insomnia are an effective adjunctive tool that are used by sleep specialists to help their patients. The Sleep Clinic offers its patients access to the AASM approved Shut-I program at a discount.  Studies have recognized the Shut-I program as an effective resource for the treatment of insomnia.

 

Pharmacologic treatment of Insomnia.

Hypnotics are associated with an increased risk of death and are also strongly associated with poor daily function,  performance problems, memory disturbance,  and poor quality of life. The evidence suggests that hypnotics may also increase the risk of automobile accidents and falls.

In contrast, there is no strong evidence that long-term use of hypnotics has any benefit and the risks of chronic hypnotic use outweigh the benefits.

At the Sleep Clinic, hypnotic medications may be carefully used in combination with CBT and other modalities to help our patients overcome insomnia. The medication used as well as the duration of treatment are chosen in a careful and judicious manner.

Commonly prescribed hypnotics include: zolpidem (Ambien, Ambien CR, Intermezzo, Zolpimist), Eszopiclone (Lunesta), zalpelon (Sonata), ramelteon (Rozeram), temazepam (Restoril), flurazepam (Dalmane), clonazepam (Klonopin), and the most recently released suvorexant (Belsomra).

 Over the counter sleep medications typically include a class of drug known as antihistamines, which may have other effects on your health. They generally have longer duration of action resulting in daytime symptoms. Additionally, these medications may lose their effectiveness with repeated use.  Other over the counter remedies include Melatonin and herbal therapies such as Valerian.