Insomnia: What the Researchers Say in the Latest Article

Insomnia, a widespread issue that affects millions of people worldwide, is a condition that many can relate to. In a recent article published in The New England Journal of Medicine, experts Charles M. Morin, Ph.D., and Daniel J. Buysse, M.D., delve into the intricacies of this sleep disorder, its causes, and the best practices for managing it. Here, we summarize their key findings and insights to help you better understand insomnia and its treatment.

Insomnia is characterized by dissatisfaction with sleep quality or duration, often resulting in difficulty falling asleep, staying asleep, or waking up too early. According to Morin and Buysse, “Insomnia is the most prevalent sleep disorder in the general population and among the most frequent issues raised by patients during primary care visits.”

The causes of insomnia are multifaceted and can include stress, health problems, and irregular work schedules. As the researchers explain, “The first episode typically arises from stressful life situations, health problems, atypical work schedules, or travel across several time zones (jet lag).” A thorough assessment is crucial for diagnosing and managing insomnia effectively. Morin and Buysse emphasize the importance of a detailed patient history: “The assessment and diagnosis of insomnia rest on a careful history to document symptoms, course, co-occurring conditions, and other contributing factors.” This thorough process ensures that the most effective treatment plan can be developed for each individual.

When it comes to treating insomnia, Cognitive Behavioral Therapy for Insomnia (CBT-I) stands out as the first-line treatment. According to the researchers, “CBT-I involves a combination of strategies aimed at changing the behavioral practices and psychological factors that contribute to insomnia.” In addition to CBT-I, medications can also play a role in managing insomnia. “Current treatment options for insomnia include prescribed and over-the-counter medications, psychological and behavioral therapies, and complementary and alternative therapies,” note Morin and Buysse.

Benzodiazepine receptor agonists, dual orexin receptor antagonists, and sedating antidepressants are commonly used to treat insomnia. However, these medications can have potential side effects, such as drowsiness, dizziness, and the risk of dependence. The researchers highlight that these medications should be considered alternative or adjunctive treatments to CBT-I: “Medications with an indication for insomnia that the Food and Drug Administration approves are recommended as alternative or adjunctive treatments.”

Combining CBT-I with medications can provide quicker relief from insomnia, but CBT-I alone tends to produce more sustained benefits over time. As Morin and Buysse point out, “Combined therapy produces improvement in sleep more quickly than CBT-I alone, but this advantage decreases by the fourth or fifth week of treatment.” With the rise of digital health solutions, online platforms for CBT-I have gained popularity. These platforms, such as SHUTi and Sleepio, offer structured programs and personalized support and have shown substantial evidence supporting their efficacy. “Digital CBT-I has gained in popularity over the past decade and could eventually narrow the important gap between demand and access to CBT-I,” explains the researchers.

Alternative treatments, including melatonin and other complementary therapies, are also discussed. While their efficacy may not be well established, these treatments can offer potential benefits for some individuals. “Melatonin is increasingly used to treat sleep problems in children, although its efficacy and safety are not well established except in children with neurodevelopmental disorders,” said Morin and Buysse.

Approximately 10% of adults meet the criteria for insomnia disorder, and another 15 to 20% report occasional insomnia symptoms. “Insomnia is more prevalent among women and persons with mental or medical problems, and its incidence increases in middle age and later,” note the researchers. Chronic insomnia is linked to several health risks, including major depression, hypertension, Alzheimer’s disease, and work disability. “Chronic insomnia is associated with increased risks of major depression, hypertension, Alzheimer’s disease, and work disability,” they emphasize. Insomnia often co-occurs with other medical conditions, psychiatric disorders, and sleep disorders like restless legs syndrome and sleep apnea. “It frequently co-occurs with other medical conditions and psychiatric disorders, as well as other sleep disorders,” explain Morin and Buysse. Insomnia can follow a persistent course in more than 50% of patients. “Although most persons resume normal sleep after adjusting to the precipitating event, chronic insomnia may develop in persons who are vulnerable to the disorder,” they write.

Insomnia is a complex condition that significantly impacts daily life and health. However, understanding its causes and the best treatment options can bring hope. As highlighted by leading experts Morin and Buysse, a combination of behavioral therapies and appropriate medications can offer significant relief to those who have insomnia. For those struggling with sleep, seeking professional help and exploring the various treatment options available is essential. With the right approach, better sleep and improved quality of life are within reach.

The article can be accessed here.