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.