AAPA: Chronic Insomniacs Rarely Seek Help From A Doctor

PHILADELPHIA, June 4 -- Seven out of 10 patients with chronic insomnia never talk with their doctors about it. Instead, they self-medicate with over-the-counter medicines or alcohol.

According to a Gallup poll, 69% of people with chronic insomnia have never discussed it with their primary care physician, said Catherine R. Judd, P.A.-C., of the University of Texas Southwestern Medical Center in Dallas.

More than a quarter of them (26%) bring it up during an office visit for another purpose; only 5% see their doctor specifically for their insomnia, Judd told attendees at an industry-sponsored symposium held in conjunction with the American Academy of Physician Assistants meeting here.

Nearly a quarter (23%) of patients with insomnia use over-the-counter medications, and 28% of those with both insomnia and depression turn to alcohol for relief, according to recent reports, Judd said. In fact, she added, chronic insomnia is an established risk factor for substance abuse.

Furthermore, said Gary Richardson, M.D., of the Henry Ford Hospital in Detroit, Mich., 40% of people with chronic insomnia also have a co-morbid psychiatric condition such as depression or anxiety.

As many as 90% of patients with depression have at least occasional insomnia, and evidence suggests the condition may in fact be a prodromal symptom of depression, Dr. Richardson said.

To properly manage insomnia, promoting good sleep habits is the first step. However, cognitive-behavioral therapy and/or medication may also be required, said David N. Neubauer, M.D., of Johns Hopkins.

But, warned Dr. Neubauer, many of the over-the-counter herbal remedies people buy for insomnia, such as valerian root or melatonin, have not been properly evaluated by clinical trials.

Over-the-counter antihistamines, such as diphenhydramine (Benadryl), are often recommended for insomnia and have more evidence behind them, Dr. Neubauer said.

When it comes to prescription medications, he said, there are sedating antidepressants, hypnotics, and melatonin receptor agonists.

Sedating antidepressants may be efficacious in depressed patients, but they have not been well evaluated in non-depressed patients. In addition, they are known to cause daytime sedation, Dr. Neubauer said.

The efficacy of hypnotics has been established in the general population, he noted. However, some studies have suggested that they increase the risk of falls in the elderly, a population at special risk for insomnia. In addition, he said, there is the potential for tolerance or abuse with this class or drugs.

Melatonin agonists are indicated specifically for insomnia characterized by difficulty falling asleep, Dr. Neubauer said. Compared with placebo, they have not been shown to be linked with daytime sleepiness or difficulty concentrating, he said.