Medical Treatment of Insomnia

You might think that, because insomnia is so prevalent, physicians would be experts in evaluating and treating it. However, most insomniacs know the opposite is true: physicians frequently don't ask about insomnia, overlook it, or simply ignore it. Why? Because insomnia is so ubiquitous that it is often dismissed by doctors as an unavoidable and normal part of life.

Also, physicians are not trained to diagnose or treat insomnia. Even though it is one of the most frequent health complaints today, doctors receive less than one hour of training on sleep during their entire medical education.

It is easy to understand why doctors are not comfortable treating insomnia. As Dr. William Dement, an international expert on sleep disorders and Director of the Sleep Clinic at Stanford University School of Medicine, explains, "Most physicians dread the arrival of a chronic insomnia patient. If one asks a large group of doctors if any of them enjoy managing chronic insomnia, not a single hand will go up." Consequently, the vast majority of cases of insomnia go undiagnosed and untreated.

When doctors do diagnose insomnia, their evaluation is often incomplete. They frequently ask about psychological problems but rarely ask about the patient's actual sleep pattern, lifestyle issues, or relevant factors such as caffeine use. And when physicians prescribe a treatment for insomnia, they typically prescribe sleeping pills too frequently and inappropriately.

Studies also demonstrate that physicians believe sleeping pills are the most effective therapy for insomnia, even though widely disseminated studies and medical literature indicate that cognitive-behavioral therapies are more effective for chronic insomnia; and, that the National Institutes of Health clearly recommends that non-pharmacological therapies be attempted first.

Additionally, physicians are too likely to conceptualize insomnia as a psychiatric problem, even though the majority of insomniacs to not have a diagnosable psychiatric disorder!

Another problem with medical treatment of insomnia is that medicine has not developed an effective treatment for insomnia. The only medical treatment available for insomnia is sleeping pills such as Halcion, Restoril, Dalmane, Xanax, Ativan, Klonopin, and many others. Sleeping pills, however, are no longer considered a safe or appropriate treatment for chronic insomnia because they:

• Can have serious side effects that far outweigh their benefits;
• Are only moderately effective for insomnia and stop working over time;
• Strengthen the belief that the cure for insomnia comes from external factors;
• Can lead to physical or psychological dependency.

Most importantly, sleeping pills don't cure insomnia because they don't treat the causes of insomnia. Consequently, if insomniacs rely on sleeping pills, their sleep may improve while they take medication, but insomnia will return usually return if they stop taking the medication, thereby sustaining the cycle of insomnia and sleeping pills.