Psychiatr News September 16, 2005
Volume 40, Number 18, page 30
© 2005 American Psychiatric Association
Experts Issue Wake-Up Call On Insomnia Research
Lynne Lamberg
A National Institutes of Health panel advocates large collaborative
clinical trials to compare drug and nondrug therapies for troubled
sleepers.
A National Institutes of Health (NIH) panel reviewing the state of
knowledge about insomnia treatments called for a wide range of research to
elaborate the causes, mechanisms, course and consequences of, and treatments
for chronic insomnia.
"We know `way too little about all these variables,'" said
review panel chair Alan Leshner, Ph.D., chief executive officer of the
American Association for the Advancement of Science. "That is why this
was a state-of-the-science conference, not a consensus treatment
conference," he said. "Many gaps in the scientific literature need
to be filled."
Chronic insomnia is comorbid with a wide variety of medical conditions.
"It's not always clear which is causing which, a fact physicians need to
know to target treatment," Leshner said.
The panel called on the sleep community, NIH, and pharmaceutical
manufacturers to conduct randomized, controlled, multisite clinical trials to
see how pharmacological agents stack up against each other, placebo, and
cognitive-behavioral therapy (CBT) and how well combined treatments work.
These studies, the panel said, should use validated objective and
self-report measures of sleep function, wake function, and general health and
quality-of-life indicators. They should include population subgroups with a
high prevalence of insomnia and comorbid illness, such as postmenopausal women
and nursing home residents, as well as groups for which knowledge of insomnia
is sparse, such as children. Subjects should include people with primary
chronic insomnia and comorbid insomnia, not simply normal controls. Trials
should assess cost and cost-effectiveness.
The panel identified the need to carry out the following tasks:
- Develop a central registry for all insomnia trial data.
- Assess the efficacy of complementary and alternative-medicine therapies,
preferably with federal support to assure rigorous research methodology.
- Conduct longitudinal studies to identify factors that affect the incidence
of insomnia and comorbidities—such as bereavement, divorce, and major
chronic diseases—as well as the duration of insomnia.
- Explore the possible genetic etiology of chronic insomnia.
- Assess the public health burden of insomnia by including measures of sleep
in epidemiological studies. To aid this goal, the 2005-2006 National Health
and Nutrition Examination Survey will include 23 questions on sleep.
Interviewers will ask subjects to report how long they take to fall asleep and
how long they sleep, the nature of sleep problems they experience, and whether
they have trouble with concentration, memory, work, driving, and other aspects
of daily life because they feel too tired or sleepy. The panel urged that
measures of sleep also be added to other epidemiological studies.
- Identify direct and indirect costs of chronic insomnia and potential
societal benefits, such as improved work and academic performance and higher
quality of life, of successful intervention programs.
- Assess the impact of chronic insomnia on families and caregivers, who may
be forced to lose sleep themselves.
- Train more specialists and primary care practitioners in CBT.
- Study physician prescribing and decision-making behaviors.
- Encourage primary care physicians and other health professionals to ask all
patients about sleep in routine evaluations.
- Educate the general public about sleep, sleep disorders, and health habits
that contribute to good sleep.
The panel arrived at its recommendations after hearing two days of
presentations on insomnia by sleep experts. In closed-door deliberations, it
then considered comments from conference attendees and a review of scientific
literature supplied by the Agency for Healthcare Research and Quality. Panel
members lost some sleep themselves in the process: they completed their draft
report at 3:15 a.m.
The 12-member multidisciplinary panel included Charles Zorumski, M.D.,
chair of psychiatry, and Lee Robins, Ph.D., emeritus professor of social
science in psychiatry, both at Washington University School of Medicine in St.
Louis. The National Institute of Mental Health and Office of Medical
Applications of Research were the lead sponsors of the conference.
A Webcast of the conference proceedings, literature review, and
panel's report are posted at
<http://consensus.nih.gov/>.
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