Insomnia Remedies

Over 1.6 Million Americans Use CAM for Insomnia or Trouble Sleeping

A recent analysis of national survey data reveals that over 1.6 million American adults use some form of complementary and alternative medicine (CAM) to treat insomnia or trouble sleeping* according to scientists at the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health. The data came from the 2002 National Health Interview Survey (NHIS) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention.

In 2002 the NHIS, an in-person, annual health survey, included over 31,000 U.S. adults aged 18 years and older. A CAM supplement to the survey asked about the use of 27 types of CAM therapies, as well as a variety of medical conditions for which CAM may be used, including insomnia or trouble sleeping. Survey results show that over 17 percent of adults reported trouble sleeping or insomnia in the past 12 months. Of those with insomnia or trouble sleeping, 4.5 percent - more than 1.6 million people - used some form of CAM to treat their condition.

"These data offer some new insights regarding the prevalence of insomnia or trouble sleeping in the United States and the types of CAM therapies people use to treat these conditions," said Dr. Margaret A. Chesney, Acting Director of NCCAM. "They will help us develop new research questions regarding the safety and efficacy of the CAM therapies being used."

Those using CAM to treat insomnia or trouble sleeping were more likely to use biologically based therapies (nearly 65 percent), such as herbal therapies, or mind-body therapies (more than 39 percent), such as relaxation techniques. A majority of people who used herbal or relaxation therapies for their insomnia reported that they were helpful. The two most common reasons people gave for using CAM to treat insomnia were they thought it would be interesting to try (nearly 67 percent) and they thought CAM combined with a conventional treatment would be helpful (nearly 64 percent).

In addition to looking at the data on CAM use and insomnia, the researchers also looked at the connection between trouble sleeping and five significant health conditions: diabetes, hypertension, congestive heart failure, anxiety and depression, and obesity. They found that insomnia or trouble sleeping is highly associated with four of the five conditions: hypertension, congestive heart failure, anxiety and depression, and obesity.

Panel Calls for a New Look at Treatments Commonly Used for Chronic Insomnia

Many of the medications widely used to manage chronic insomnia have not yet been rigorously evaluated for long-term use, according to an independent scientific panel convened this week by the National Institutes of Health. This is a critical consideration because for many patients, insomnia can persist for decades. The panel also stressed that many chronic insomnia sufferers could benefit from currently underused behavioral and cognitive therapies.

The panel was concerned that many of the drugs now used to treat insomnia, such as antidepressants and antihistamines, have not been approved for this indication; their efficacy in treating chronic insomnia has not been proven. Even those medications that have been approved for insomnia are approved only for short-term use, leaving chronic sufferers with few proven options. The panel noted that newer benzodiazepine receptor agonist medications have been developed that have fewer and less severe adverse effects than other medications, and show promise for long-term use, but this requires further evaluation. The panel also expressed concern that many insomnia sufferers self-medicate with alcohol, despite the numerous risks involved and the clear evidence that alcohol actually has a negative overall effect on the quality of sleep.

Research indicates that behavioral methods such as relaxation training can be effective to treat insomnia when combined with cognitive therapies specifically targeted at anxiety-producing beliefs and erroneous beliefs about sleep and sleep loss. Moreover, this approach is unlikely to carry adverse side effects, and its benefits may be longer lasting than pharmacological interventions. There are few practitioners trained in these therapies, however.

Alan Leshner, Ph.D., Chief Executive Officer of the American Association for the Advancement of Science and chair of the conference panel explained, "we know that patients can struggle for years with insomnia, and we know that they use a variety of over-the-counter and prescription drugs to deal with it. Unfortunately, we found insufficient evidence to recommend most of these treatments for long-term use. There's a clear need for more research to fill this gap."

The panel's full statement discusses the specific challenges facing this area of research and recommends a variety of studies to help clarify the disorder's underlying mechanisms, natural history, the interaction between insomnia and other conditions, and the comparative risks and benefits of various therapies.

The panel released its findings this morning, following two days of expert presentations and panel deliberations. Full text of the panel's draft state-of-the-science statement will be available late today at http://consensus.nih.gov. The final version will be available at the same Web address in three to four weeks. Statements from past conferences and additional information about the NIH Consensus Development Program are also available at the Web site.

How Is Insomnia Diagnosed?

Your doctor will usually diagnose insomnia based on your medical history, sleep history, a physical exam, and a sleep study if the cause of your insomnia is unclear.

Medical History

Your doctor will ask questions to find out whether there is a medical cause for your insomnia. These include questions about whether you:

Have any new or ongoing health problems
Have painful injuries or health conditions (such as arthritis)
Take any medicines (over-the-counter or prescription)

Other questions are aimed at finding work or leisure habits that might be causing your insomnia. Your doctor may ask about your work and exercise routines; your use of caffeine, tobacco, or alcohol; and your long-distance travel history.

Your doctor also may ask whether you have any new or ongoing work, personal problems, or other stresses in your life. In addition, you may be asked whether you have other family members with sleep problems.

Sleep History

To get a better sense of your sleep problem, your doctor will ask you details about your sleep habits, including:

How often you have trouble sleeping and how long the problem has persisted
When you go to bed and get up on workdays and days off
How long it takes you to fall asleep, how often you wake up at night, and how long it takes to fall back asleep
If you snore loudly and frequently, or wake up gasping or feeling out of breath
How refreshed you feel when you wake up, and how tired you feel during the day
How often you doze off or have trouble staying awake during routine tasks, especially driving

You may be asked to keep a sleep diary for 1 to 2 weeks so you can answer these questions easily. Your bed partner may help you keep the sleep diary.

To see what might be causing or worsening your insomnia, your doctor will also ask you:

Whether you worry about falling asleep, staying asleep, or getting enough sleep
What you eat or drink, and whether you take medicines before going to bed
What routine you follow before going to bed
What the noise level, lighting, and temperature are like where you sleep
What distractions, such as a TV or computer, might be in your bedroom

Physical Exam

Your doctor will do a physical exam to rule out other medical problems that might cause insomnia. You may also need blood tests to check for thyroid problems or other conditions that can cause sleep problems.

Sleep Study (Polysomnogram)

A polysomnogram is a recording of your breathing, movements, heart function, and brain activity during sleep. For this study, you sleep overnight at a special sleep center. Your doctor usually will recommend a sleep study if you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome.