Magazine article Drug Topics

Insomniacs Asleep When It Comes to Getting Help

Magazine article Drug Topics

Insomniacs Asleep When It Comes to Getting Help

Article excerpt

Insomniacs asleep when it comes to getting help

Insomniacs know all kinds of interesting things. They know, for instance, what time the old Ben Casey reruns are shown. They can tell you how to order the accumulated hits of Peter Lemongello, how people with bad credit records can get major charge cards (even if they've been turned down before!), how to call up true love on a 900 number, or how to dial-a-psychic.

People who don't sleep also know how many of their neighbors, on average, have lights burning in the wee hours. They know down to the last withered grape what their refrigerators contain. And, more than anything else, they know that without sleep the following day will be a rough go.

Help available: What they don't seem to know is that they can and should seek help. "Studies seem to indicate that maybe, maybe, 5% to 6% of people with insomnia ever got a sleeping pill," Thomas Roth, chief of the division of sleep disorders and research at Detroit's Henry Ford Hospital, told Drug Topics. "The overwhelming majority of insomniacs have never been treated."

Now consider that the U.S. market for prescription sleep aids is placed at about $210 million, according to Abbott Laboratories. That hefty amount offers no clue to the actual number of people suffering through sleepless nights. "Whatever that figure is, and I'm sure they know markets better than I do," Roth laughed, "as an estimate of insomnia it's a massive understatement."

For one thing, it doesn't include the over-the-counter hypnotics, Roth said. For another, it doesn't take into account all the people who self-medicate with alcohol. Millions try that tactic, the researcher said, and "it's a terrible idea." Alcohol will induce drowsiness, but once it's metabolized it fragments sleep.

"People feel they should be able to do something about it (insomnia) themselves," observed James Walsh, director of the sleep disorders and research center at Deaconess Hospital in St. Louis. They report the problem to their physicians once or twice, the doctor says not to worry about it, and, after getting little attention, they're reluctant to bring it up again.

But they should insist on being heard. At the minimum, Roth said, patients should "very quickly talk to the family practitioner," because insomnia is not a trivial symptom. It can be downright disabling.

He futher pointed out that insomnia can result from a multitude of possible causes. It's important, Walsh agreed, to find the source of the problem and then treat it as directly as possible. For instance, a physical and drug history may indicate that management of another ailment is provoking sleeplessness.

Steroids, Roth said, have been reported to cause insomnia. Theophylline, or "high-test caffeine," is another potential culprit, he added. Certain antihypertensive drugs and cholesterol-lowering agents have also been implicated.

Insomnia can be transient, shortterm, or chronic. Transient episodes, observed Roth, may be caused by jet lag or an acute hospitalization. The short-term variety tends to last for several days or weeks, while long-term cases are often connected with physical or psychiatric ills such as depression.

"Most of us have transient insomnia every now and then," Walsh said. When it starts to become predictable, a hypnotic can be "quite effective." For example, the person who can't sleep before a monthly business presentation might be a good candidate for treatment. "That's probably the best situation in which to use sleeping pills," he added.

Safe, effective: The benzodiazepine sedative hypnotics have proved to be effective and quite safe as a class, the two researchers noted. …

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