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You Can Say Good Night to Insomnia

Bedtime is approaching and Alan is dreading it. He knows what tonight will bring: the torment of another night of insomnia.

Each night has become agonizingly familiar. Exhausted, Alan gets into bed and turns out the lights to go to sleep, only to lie wide awake. The harder he tries to fall asleep, the more he tosses and turns and the more tense and frustrated he feels. With the realization that he can’t fall asleep comes a distressing wave of anxiety and stressful thoughts about sleep—"I’ve got to get some sleep or I’ll never function tomorrow!"—and the worries about the problems in his life: tomorrow’s meeting, Friday’s deadline, his company’s downsizing, his mother’s illness. All are made worse by the loneliness and darkness of the night.

Even when Alan finally falls asleep he cannot escape insomnia. After just a few hours, he wakes up and tosses and turns before falling back to sleep just as the sun rises.

When the alarm clock rings, Alan has to drag himself out of bed, angry and depressed in the knowledge that yet another day feeling wiped out, helpless, and desperate awaits him.

Insomnia has become Alan’s living nightmare.

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Does Alan’s ordeal sound familiar? It does for most insomniacs, who live in an interminable state of anxiety concerning insomnia and its effects on their lives. Like Alan, they also feel hopeless, powerless, and trapped by their lack of control over sleep, and they dread what, for most people, is an enjoyable experience—going to bed.

And no wonder. The anger, exhaustion, and irritability caused by insomnia can handicap mood, productivity, coping skills, and family and social life, and deprive insomniacs of a sense of joy and well-being. They grow even more frustrated or depressed by family or friends who tell them "it’s all in your head" or "just relax," and may start to wonder whether they have a "psychological" problem. As a consequence, insomniacs feel embarrassed or even ashamed about their condition, which diminishes their self-esteem.

Doctors and Sleeping Pills

It is stressful enough to endure insomnia, but many doctors’ reactions to it can make it even worse. They 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!

Doctors 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 problems during their entire medical education. This lack of training is compounded by the fact that, until recently, little federal funding has been allocated for insomnia research, which means that information about treating insomnia is not available to doctors in medical and scientific journals. (Fortunately, Congress and the National Institutes of Health have started to appropriate more money for sleep and insomnia research, as evidenced by the decision to fund my own research for four years.)

It is easy to understand why doctors are not comfortable treating insomnia. And when they are not comfortable treating something, they are inclined to avoid it. 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." It is no wonder that the vast majority of cases of insomnia go undiagnosed and untreated!

There is another reason insomniacs can’t turn to their doctor for help: medicine has not developed an effective treatment for insomnia. Until recently, the only medical treatments available were 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; and can lead to physical or psychological dependency, which can cause feelings of helplessness, loss of control, and lowered self-esteem.

Most important, sleeping pills don’t cure insomnia, because they don’t treat the causes of insomnia. Consequently, if you rely on sleeping pills, your sleep may improve while you take the pills, but as soon as you stop, your insomnia will return, thereby sustaining the cycle of insomnia and sleeping pills.

Given everything we know about the drawbacks to sleeping pills, why do so many doctors still prescribe them? Partly because when doctors are busy and don’t know what to do about insomnia, sleeping pills are a fast and easy solution. Another reason is the pervasive influence of drug companies, which sponsor scientific conferences, advertise in medical journals, send sales personnel to doctors’ offices, supply free samples of sleep medications, and fund research studies that pay part of doctors’ salaries. Therefore, doctors may be subtly influenced to prescribe the sleeping pills that the drug companies manufacture.

Doctors also prescribe sleeping pills because of the predominant attitude in medicine today that drugs are the best treatment for health problems. This drug-oriented approach, which focuses on treating the body, has worked well for acute and infectious illnesses.

However, it has been largely ineffective in the treatment of today’s chronic health problems such as stroke, heart disease, arthritis, cancer, insomnia, chronic pain, and mental illness, in which emotional, behavioral, and lifestyle factors play a prominent role.

Psychotherapy and Over-the-Counter Sleep Aids

Not surprisingly, 85 percent of insomniacs never seek medical help. Insomnia has become an epidemic affecting desperate, silent sufferers who, believing that their doctors can’t help them or will prescribe habit-forming prescription sleeping pills, have been left to fend for themselves, typically spending years battling the problem futilely and suffering needlessly.

You may be one of the many insomniacs who have turned to expensive, time-consuming psychotherapy in your belief, or perhaps your doctor’s, that insomnia is caused by "psychological problems." Not only does this belief induce feelings of helplessness and diminished self-esteem; there also is no scientific proof that psychotherapy is effective for insomnia, in large part because the majority of insomniacs do not have a psychiatric problem such as anxiety or depression. This is why trying to treat insomnia as a problem caused by psychiatric factors is destined to fail and only contributes to the stigma of insomnia being a "psychiatric" problem.

Millions of other insomniacs have turned to a slew of new over-the-counter nighttime sleep aids such as Tylenol PM, Excedrin PM, and Anacin PM, whose manufacturers have capitalized on this epidemic. These products, cloaked in the brand names of trusted medicines, avoid the stigma associated with prescription sleeping pills. Consequently, they are one of the fastest-growing classes of...