By Sherwood, Devon A; Rey, Jose A
Drug Topics , Vol. 151, No. 13
Insomnia is one of the most commonly reported medical and psychiatric conditions in the United States. For practitioners capable of dozing off during the constant advertising campaigns of agents for insomnia, several factors should serve as a wake-up call about how important treating insomnia is in the medical community. Numerous studies have emerged indicating links between insomnia and several medical disorders, including heart disease, hypertension, diabetes, obesity, neurological disease, breathing problems, urinary problems, chronic pain, gastrointestinal problems, and mental disorders.
Insomnia is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition, Text Revision, as "difficulty falling asleep, maintaining sleep, early arising, or not feeling rested despite a sufficient opportunity to sleep." Diagnosis of chronic insomnia, as defined by the American Psychiatric Association as well as the National Institutes of Health, requires that these symptoms persist for at least one month and lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning. Recent statistics estimate that more than half (54%) of the U.S. population report symptoms of insomnia a few nights a week and 33% report symptoms every night. Insomnia is the most common sleep disorder and is linked with an increase in overall mortality.
The following information should serve as a warning to all healthcare providers that the treatment of insomnia needs to become a priority today. Deficits in knowledge about sleep medicine and time constraints are both contributing factors regarding the wariness physicians demonstrate regarding treatment. Studies demonstrate that physicians detect insomnia in less than 50% of patients who have insomnia symptoms. Studies have also shown time spent on counseling patients about the benefits of sleep was less than the time spent discussing diet or exercise. They also found that primary care providers often rate their knowledge regarding insomnia as fair or poor. Both knowledge testing and attitude assessment results coincided with the physician self-assessments.
Consequences of untreated insomnia
Insomnia is correlated with a risk factor for mortality and nursing home placement in the elderly. This is especially problematic knowing that currently 20% to 40% of Americans aged 65 years and older report symptoms of chronic insomnia. In addition to medical issues, studies have linked insomnia in the elderly with statistically higher rates of dependence on sleep medications, self-medication with alcohol, depression, mood disorders, and other psychiatric illnesses. Insomnia is also related to progressive cognitive impairment and decreased social interaction.
In April 2006, the American Heart Association released an epidemiological study in Hypertension regarding an association between short sleep duration and high blood pressure. The study assessed whether short sleep duration would increase the risk for hypertension in 4,810 patients (4,555 men and 255 women, aged 32 to 86 years). Four groups were formed according to duration of sleep in hours (five hours or less, six hours, seven to eight hours, nine hours or more). Among patients aged 32 to 59 years, the increased incidence of hypertension more than doubled in subjects who reported averaging five hours or less of sleep per night. Patients aged 60 to 86 years did not have any association noted regarding sleep and hypertension.
A cross-sectional study reviewed the role of short or poor sleep and the association with glycemic control in 161 African-Americans (42 men, 119 women) with Type 2 diabetes mellitus. It demonstrated that sleep duration and quality of sleep were significant predictors of A1c changes. This study also reviewed 11 epidemiologie studies that examined the association between sleep and diabetes. Nine of the 11 studies demonstrated an increased risk in the incidence of diabetes when sleep deprivation was present, and two of the 11 showed no change. …