Video: Sleepless in the U.S.

updated 6/15/2005 7:50:24 PM ET 2005-06-15T23:50:24

Chronic insomnia is a major public health problem affecting millions of Americans, but there’s far too little research to know how to best treat them, what causes their sleep disruption or its health consequences, an expert panel told the National Institutes of Health Wednesday.

The most common treatments — over-the-counter allergy medicines that cause drowsiness, alcohol or an old antidepressant — come with little evidence that they help and can themselves cause problems, warned the panel’s draft conclusions.

The best treatment options to date are behavioral/cognitive therapy — training people to reduce anxiety and take other sleep-promoting steps — and a handful of newer prescription sleep agents, the panel found. But even those newer drugs haven’t been studied for more than brief use, panelists said.

About a third of adults complain of problems sleeping, while about 10 percent have symptoms of daytime impairment that seem to be true insomnia.

But what causes it remains a mystery.

It often accompanies depression or any of a host of other medical problems, from arthritis to diseases of the heart, lungs and brain. Yet it’s hard to tell if the insomnia came first or was a result of the other diseases — and how trouble sleeping in turn complicates those other problems. That’s critical to learn, because it could affect patients’ treatment, panelists said.

The risk of insomnia does seem to increase with age, possibly because of declining health, and it’s more common among women, especially after menopause. Smoking, alcohol, coffee and numerous prescription drugs also affect sleep. Yet while there are lots of theories that the hectic pace of today’s society might play a role, too, there’s no actual proof.

The bottom line, the NIH panel said: Insomnia’s a big enough health concern to warrant major new research into its causes and treatments, along with concerted education for doctors and the public.

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