|Panel Calls for a New Look at Treatments Commonly Used for Chronic Insomnia
NIH State-of-the-Science Panel Also Recommends Broader Use of Cognitive
and Behavioral Therapies
Many of the medications widely
used to manage chronic insomnia have not yet been rigorously evaluated
for long-term use, according to an independent scientific panel
convened this week by the National Institutes of Health. This is
a critical consideration because for many patients, insomnia can
persist for decades. The panel also stressed that many chronic insomnia
sufferers could benefit from currently underused behavioral and
The panel was concerned that many of the drugs now used to treat
insomnia, such as antidepressants and antihistamines, have not been
approved for this indication; their efficacy in treating chronic
insomnia has not been proven. Even those medications that have been
approved for insomnia are approved only for short-term use, leaving
chronic sufferers with few proven options. The panel noted that
newer benzodiazepine receptor agonist medications have been developed
that have fewer and less severe adverse effects than other medications,
and show promise for long-term use, but this requires further evaluation.
The panel also expressed concern that many insomnia sufferers self-medicate
with alcohol, despite the numerous risks involved and the clear
evidence that alcohol actually has a negative overall effect on
the quality of sleep.
Research indicates that behavioral methods such as relaxation training
can be effective to treat insomnia when combined with cognitive
therapies specifically targeted at anxiety-producing beliefs and
erroneous beliefs about sleep and sleep loss. Moreover, this approach
is unlikely to carry adverse side effects, and its benefits may
be longer lasting than pharmacological interventions. There are
few practitioners trained in these therapies, however.
Alan Leshner, Ph.D., Chief Executive Officer of the American Association
for the Advancement of Science and chair of the conference panel
explained, "we know that patients can struggle for years with
insomnia, and we know that they use a variety of over-the-counter
and prescription drugs to deal with it. Unfortunately, we found
insufficient evidence to recommend most of these treatments for
long-term use. There's a clear need for more research to fill this
The panel's full statement discusses the specific challenges facing
this area of research and recommends a variety of studies to help
clarify the disorder's underlying mechanisms, natural history, the
interaction between insomnia and other conditions, and the comparative
risks and benefits of various therapies.
The panel released its findings this morning, following two days
of expert presentations and panel deliberations. Full text of the
panel's draft state-of-the-science statement will be available late
today at http://consensus.nih.gov.
The final version will be available at the same Web address in three
to four weeks. Statements from past conferences and additional information
about the NIH Consensus Development Program are also available at
the Web site, or by calling 1-888-644-2667.
The 12 members of this State-of-the-Science panel were nominated
for selection by peers who were confident that these individuals'
areas of expertise would significantly contribute to the process
of critically examining scientific evidence on insomnia. The panel
included educators, researchers, statisticians, and practitioners
in neuroscience, anesthesiology, sleep disorders, geriatric medicine,
psychology, psychiatry, epidemiology, health services research,
nursing, and community medicine.
In addition to the presentations of conference speakers, the panel
considered a comprehensive systematic literature review prepared
by the University of Alberta Evidence-Based Practice Center, under
contract with the Agency for Healthcare Research and Quality (AHRQ).
The panel's statement is an independent report and is not a policy
statement of the NIH or the Federal Government. The NIH Consensus
Development Program, of which this conference is a part, was established
in 1977 as a mechanism to judge controversial topics in medicine
and public health in an unbiased, impartial manner. NIH has conducted
119 consensus development conferences, and 25 state-of-the-science
(formerly "technology assessment") conferences, addressing
a wide range of issues.
The conference was sponsored by the Office of Medical Applications
of Research (OMAR) and the National Institute of Mental Health.
Cosponsors included the National Center for Complementary and Alternative
Medicine, the National Heart, Lung, and Blood Institute, the National
Institute of Neurological Disorders and Stroke, the National Institute
of Nursing Research, the National Institute on Aging, the National
Institute on Alcohol Abuse and Alcoholism, the National Institute
on Drug Abuse, the Office of Research on Women's Health, and the
U.S. Food and Drug Administration.
Note to Radio Editors: An audio report of the
conference results will be available after 4 p.m. today from the
NIH Radio News Service by calling 1-800-MED-DIAL (1-800-633-3425).
Note to TV Editors: The news conference at 2 p.m.
today will be broadcast live via satellite on the following coordinates:
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