APSS: New drugs for insomnia will focus on safety

MINNEAPOLIS, Minn., June 14 -- Sleep specialists here reviewed the problems and alternatives for treating insomnia.

"We have always been able to get a person to sleep," said David Neubauer, M.D., of Johns Hopkins. "We have been able to get people to sleep since the ancient Greeks. The problem has always been to get them awake again."

"But there is a tremendous array of new products coming that will allow us to not only treat large numbers of people with safer products, but will also allow us to find specific products that may be perfect for specific patients," he told listeners at an industry-sponsored symposium held in conjunction with the Associated Professional Sleep Societies meeting.

"As our understanding of the fundamental process regarding the sleep-wake cycle evolves, new pharmacologic targets will be revealed," he said.

"Eighty percent to 90% of our patients are comorbid insomniacs," said Phyllis Zee, M.D., Ph.D., of Northwestern University, demonstrating that simple one-pronged treatment is unlikely to be able to succeed.

Ruth Benca, M.D., Ph.D., from the University of Wisconsin at Madison, noted that, for many people who can't get to sleep at night, the problem lies with a build-up of negative stressful events.

Those life stressors make it difficult to get to sleep, make it difficult to maintain sleep, contribute to poor quality sleep, and contribute to early-morning awakening, she said.

"The treatment of insomnia should include training in stress management and better coping strategies," Dr. Benca said. "Treatment interventions should be targeted at managing stress levels and reducing the impact of stressors."

One way of achieving that end is the use of cognitive behavioral therapy, said Charles Morin, Ph.D., of Laval University in Quebec.

"There is no pill for CBT (Cognitive Behavioral Therapy)," Dr. Morin said. "You have to spend time talking with the patient."

However, he said, the therapy does work and studies show that it can work in just one session, although it may take up to four.

It can also be effective when conducted by a nurse practitioner, he said.

The barriers to the treatment included stigma about insomnia, a lack of information about treatment options, the health care provider's lack of time and training, and the consideration of insomnia as a low health care priority. Costs and lack of availability are other factors.

"Cognitive behavioral therapy is not a quick fix," he said. "But there is increasing evidence that it is an effective treatment for primary and comorbid insomnia."