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Doctors should question patients about insomnia

Doctors should routinely question patients about sleep problems, as insomnia can increase the risk of a number of serious health conditions, experts say,

Left untreated, insomnia can increase the risk of developing potentially life-threatening conditions such as depression, diabetes and high blood pressure, but it often goes unrecognised and untreated, a review published online in The Lancet stated.

Around one in four adults experiences sleep problems, and up to one in ten suffers from insomnia. Typical symptoms include having difficulty falling or staying asleep, or feeling unrefreshed after a night's sleep. During the day people with insomnia can also suffer from fatigue, trouble concentrating and mood disturbances.

Most people with the condition are vulnerable to recurrent episodes and research suggests that nearly 70 per cent of those with insomnia continue to experience symptoms a year later, and half still have insomnia up to three years later.

The authors of the review, Dr Charles Morin from the Université Laval, Québec City, and Ruth Benca from the University of Wisconsin, Madison, said insomnia can lead to "substantial long-term effects" on people's physical and mental wellbeing.

People with insomnia are more than five times as likely to experience anxiety and depression, are at more than double the risk of developing congestive heart failure and diabetes, and are at a higher risk of premature death, the authors said.

They highlighted a study which found that people with insomnia were seven times more likely to abuse alcohol or drugs over the next three and a half years compared to those without the condition.

Although many with insomnia turn to over-the-counter medicines for the sleep disorder, the authors said there was "little evidence" of their effectiveness.

Despite the widespread use of prescription drugs and many turning to over-the-counter treatments for insomnia, the long-term use of these drugs has not been not been well studied, the authors said.

The National Institutes of Health in the US states that only two treatments - cognitive behavioural therapy (CBT) and approved hypnotic drugs - have sufficient evidence to support their use for the treatment of insomnia.

CBT uses psychological and behavioural methods such as relaxation techniques, sleep restriction, stimulus control, and education about sleep hygiene (e.g. diet, exercise, and the bedroom environment).

In addition to being an effective treatment for insomnia, CBT does not carry the risk of side effects, a clear advantage over drug treatment, said the authors, who added there was a shortage of therapists.

"Although CBT is not readily available in most clinical settings, access and delivery can be made easier through the use of innovative methods such as telephone consultations, group therapy, and self-help approaches via the internet," the authors said.

"In view of the high prevalence and substantial morbidities of insomnia, patients should routinely be asked about sleep problems by health-care providers.

"There is an urgent need for more public education about sleep and broader dissemination of evidence-based therapies for insomnia, and education and training to prepare health-practitioners to attend and treat insomnia complaints according to clinical guidelines."

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