Are Doctors Sleepwalking Through Treating Your Insomnia?

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Author:

Eric Sabo

Medical Reviewer:

Qanta Ahmed, MD

Medically Reviewed On: June 21, 2005

Desperate to get a good night?s rest, insomniacs may be forgiven for counting sheep, popping an allergy pill or drinking a glass of wine. While all of these have only the slightest connection to promoting a deep, restful sleep, doctors may not be able to do much better.

Despite a growing list of sleeping pills that have gained the government?s stamp of approval, doctors seem to be treating insomnia with just about everything else. The number one prescribed drug for restless sleepers is Desyrel, an antidepressant that has never been approved for insomnia. Close on its heels are similar treatments for depression, along with sedative drugs that are meant to treat conditions ranging from bipolar disorder to allergies.

Dr. Vaughn McCall, chair of the department of psychiatry and behavioral medicine at Wake Forest University, said that these drugs can make people drowsy enough to fall asleep. Even so, he cautioned, "there?s very little evidence that they work for insomnia."

Indeed, a great deal of confusion surrounds the question of what is the best approach to treat the millions of Americans who have chronic sleep problems. In a 2005 special insomnia meeting, organized by the National Institutes of Health (NIH), even a panel of experts had trouble answering this problem and called for further research.

"There are many gaps in the scientific literature that need to be filled," said Dr. Alan Leshner, who headed the NIH panel.

The Difference with Insomnia
Just about everyone will have a bad night?s sleep at some point, but insomnia can keep people tossing and turning for months on end. Drugs called benzodiazepines are specifically designed to treat chronic insomnia. The Food and Drug Administration (FDA) has also approved a group of newer sleeping pills, including Ambien, Sonata and Lunesta.

But there has been a puzzling shift in the management of sleep disorders, said McCall, which dates back to the 1980s. Between 1987 and 1996, the number of prescriptions for FDA-approved insomnia medications dropped by 54 percent, while the use of Desyrel and other sedating antidepressants increased 146 percent.