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Back To Vidyya International Sleep Experts Issue New Guidelines For Improving The Diagnosis And Treatment Of Insomnia

Thorough Diagnosis and Tailored Treatment Plan May Help Overcome The Common Sleep Disorder

An international panel of sleep experts issued new insomnia management guidelines, published in this month's issue of the International Journal of Clinical Practice, to address the underdiagnosis and insufficient treatment of the common sleep disorder. The guidelines were developed in response to a lack of awareness of insomnia, despite its high prevalence. In fact, most Americans have never initiated a conversation about sleep problems with a doctor, and nearly two-thirds say doctors have not asked how well they sleep, according to a recent National Sleep Foundation survey.

"Recognizing that insomnia is a serious medical disorder and obtaining a thorough diagnosis are the first steps toward overcoming this disorder," said lead author Thomas Roth, Ph.D., the director of research and division head of the Sleep Disorders and Research Center at Henry Ford Health System in Detroit. "After a proper diagnosis is made, the guidelines suggest that the combination of behavioral therapies and a medication that addresses the limitations of older sleeping pills offers the most successful results for managing insomnia."

The guidelines, titled Consensus for the Management of Insomnia in the New Millennium, recommend that a proper diagnosis for insomnia includes a physical exam and comprehensive medical and sleep history. Physicians should investigate various possible causes of sleeplessness, such as other medical and psychiatric disorders and poor sleep habits, before initiating treatment.

Once a diagnosis has been made, the guidelines state that physicians should establish a tailored treatment plan that includes a sleep medication classified as a benzodiazepine-receptor agonist, such as zaleplon. In particular, the guidelines note that this medication does not cause the side effects associated with older medications, such as dependence and next-day residual effects. Therefore, people can take the medication only after experiencing sleeplessness, even in the middle of the night, rather than in anticipation of sleep problems -- a new goal in insomnia management, according to the guidelines.

"The fear of a 'hangover effect' the next day, along with the risk of dependence associated with many sleeping pills, may have kept some patients from seeking treatment," said Dr. Roth. "These concerns can be eliminated by combining newer medications with careful monitoring by a physician."

About the guidelines

The guidelines were drafted in consultation with 13 of the top sleep researchers in the world, who convened last July at the XXIInd Congress of the Collegium Internationale Neuro-Psychopharmacologicum (CINP) in Brussels, a meeting ground for over 1,000 scientists and clinicians from 45 countries dedicated to excellence in the field of neuropsychopharmacology. In addition to Dr. Roth, the authors include Goran Hajak, M.D., Ph.D., Georg-August Universitat, Germany, and T. Bedirhan Ustun, M.D., Ph.D., World Health Organization, Switzerland.

Impact of Insomnia

Insomnia affects more than 84 million Americans, and is characterized by difficulty initiating or maintaining refreshing, restorative sleep. Insomnia is associated with dramatic impairments of psychosocial function and quality of life. In particular, people with insomnia report poorer physical and mental well-being, including higher levels of depression and anxiety. When compared with those who do not report sleep problems, people with insomnia report significant alterations in their concentration, memory, ability to accomplish daily tasks, and enjoyment of interpersonal relationships. In addition, people with insomnia generally have more medical complaints, and seek medical care more often than people without insomnia.

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Editor: Susan K. Boyer, RN
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