Insomnia is a major health problem

Insomnia is a serious medical condition that should be treated with evidence-based medicine because it is linked to depression, diabetes, hypertension, drug abuse and even death, according to a review of recent research co-authored by a leading University of Wisconsin-Madison sleep researcher.

"This review underscores the fact that insomnia needs to be taken seriously, and that health care providers should routinely ask their patients how they are sleeping," says Ruth Benca , director of the Wisconsin Sleep laboratory and clinic.

Her review appears in The Lancet.

About 25 percent of adults have sleeping problems and an estimated six to 10 percent have an insomnia disorder. Insomniacs have trouble falling or staying asleep, a lack of restorative sleep and daytime symptoms such as fatigue, trouble concentrating and mood disorders.

Benca and co-author Charles Morin from the Université Laval, Québec City, Canada, are well-known sleep researchers who reviewed more than 130 recent studies on human sleep. Their analysis showed that people with insomnia:

• Are fives times more likely to experience anxiety and depression
• Have double the risk of developing congestive heart failure and diabetes, and have an elevated risk of death
• Are seven times more likely to abuse alcohol or drugs over the next three and a half years compared with those without the condition
• Are likely to have continuing problems; 70 percent have insomnia a year later, and half still have insomnia up to three years later
• May be treated with drugs such as anti-depressants and antihistamines that have little evidence to show they work well for insomnia

"Whether insomnia appears along with these other conditions, such as depression and hypertension, or whether it causes them, it still needs to be treated," says Benca. "And our review suggests that we need more research on the best clinical guidelines for treating patients with insomnia."

The studies show that the best results come from treatment with cognitive behavioral therapy (CBT) and from hypnotic drugs such as Zaleplon and Zolpidem. CBT has none of the risks of drugs and uses methods such as relaxation techniques, sleep restriction, stimulus control, and education to produce better sleep. However, the authors note that there is a shortage of practitioners trained in CBT for insomnia.

They conclude: "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."