Insomniacs Suffer Depression, Heart Woes After Years of Little Sleep

Doctors say pills are not the best way to treat lasting insomnia.

ByCARRIE GANN, ABC News Medical Unit
January 19, 2012, 6:43 PM

Jan. 20, 2012— -- Editor's Note: The original published text of this story began with an anecdote about a man who claimed to suffer from insomnia. ABC News has deleted that portion of the text after learning that the subject was not who he represented himself to be, leading to concerns about the truthfulness of his statements.

Regularly shortchanging yourself on sleep might be more dangerous than you think, researchers say.

Insomnia is the most common sleep disorder, according to an article published Thursday in the journal Lancet. But it often goes unrecognized and untreated. Doctors say it's an alarming trend because of increasing evidence that untreated insomnia causes other health problems and can lead people to rely on sleep aids that don't work.

Almost everyone has trouble falling asleep, staying asleep or feeling well-rested after sleeping at some point. But these occasional frustrations become insomnia when they happen for days or weeks at a time, according to the National Institutes of Health. Insomnia that lasts for a month or more is chronic.

Studies have shown that 6 to 10 percent of adults meet the criteria for an insomnia disorder. But many people deal with sleepless nights and exhausted days for years at a time.

Charles Morin, a professor of psychology at Université Laval in Quebec City, Canada, and an author of the Lancet editorial, said that is a concern because untreated insomnia can create bigger health problems for the sleepless.

"Sometimes insomnia is a symptom of something else, like depression or hypertension," Morin said. "But it can also be a cause of the problem. It can go in both directions."

People with insomnia were five times as likely to develop depression or anxiety and more than twice as likely to have congestive heart failure, according to a U.S. National Health Interview Survey in 2002.

Stopping insomnia in its early stages would be the key to preventing these health problems from developing. But psychologists say many people don't recognize insomnia as a health problem.

"Most people won't go to their physicians right away for insomnia. They go to the drug store instead," Morin said.

Pharmacy shelves are full of pills that people use to get some shut-eye: cold and allergy medicines (the drowsy kind); synthetic versions of the body's sleep hormone, melatonin; even some anti-depressants. The problem with these drugs is that there's little evidence that actually stop chronic insomnia. Prescription sleep aids, like Ambien or Lunesta, are effective but are not intended to treat years of sleeplessness.

"Generally, the way medications are recommended is for short-term use," said Philip Gehrman, clinical director of the Behavioral Sleep Medicine Program at the University of Pennsylvania. "If you need to travel and you know you won't sleep well or you're going to have a stressful month at work, that's an appropriate use. That's short-term."

Gehrman said primary care doctors are often reluctant to prescribe sleep aids to their patients, leading many to simply not ask about their patients' sleep habits and problems at all.

"If they do ask about it, and the patient does have insomnia, they usually feel their only option will be to give one of these pills," he said.

Experts say cognitive behavioral therapy is one of the few treatments that has shown any lasting progress in stopping insomnia for good. The therapy is a four- to eight-week process that tries to train insomniacs how to sleep again. The therapy emphasizes that people should have healthy sleeping habits, only getting in bed with sleepiness hits, making sure the bedroom is comfortable and getting out of bed if sleep doesn't come. Therapists also give insomniacs relaxation techniques and strategies for quieting their minds when too many thoughts keep them awake.

Studies show the therapy often works, giving 70 to 80 percent of insomniacs some relief, and completely knocking it out for 40 percent of patients. But therapists who practice it are in short supply, and insurance plans are variable when it comes to covering the cost.

"Cognitive behavioral therapy should really be considered a first-line therapy for chronic insomnia," Morin said. "Although we might think it is more costly and time-consuming, it may be more costly in the short term, but the effects will be more long-lasting."

Morin also noted that group therapy, telephone consultations and even Internet self-help sites can help guide the sleepless through the basics of cognitive behavioral therapy. The American Board of Sleep Medicine keeps a list of certified sleep specialists who can deliver the therapy.

Morin said he hopes that more doctors will spend time making sure their patients are sleeping well.

"Sleep is really a vital sign, and doctors should keep track of it," Morin said. "We ask people about their diet and exercise habits. Sleep should be part of that as well."

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