BOSTON—Most American adults don’t get enough sleep. According to the National Institutes of Health, an estimated 30% of adults report some kind of sleep disturbance. Ten percent have chronic insomnia—and with it, pain, fatigue, mood swings, or memory problems. Sleep may be especially elusive for those with rheumatic disease. As many as 80% of these patients have sleeping problems, and half suffer from chronic insomnia.
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Explore This IssueApril 2008
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In the last few years, many people with sleep disturbances have turned to new prescription drugs to fix the problem. (Ambien, which accounts for about 60% of all sleeping-pill prescriptions in the U.S., accounted for $2.8 billion in sales last year, according to IMS Health.) But these pills often come with side effects including dizziness, nausea, and—most commonly—feelings of “drugged drowsiness” during the day.
Cognitive behavioral therapies (CBTs)—in which patients modify their day- and nighttime habits in order to restore normal sleeping patterns—have been shown to be useful alternatives to pharmacological treatments. “Virtually all insomnias have a learned component,” says Pamela Degotardi, PhD, a developmental psychologist at Queens College in New York City. “CBT teaches strategies to change these learned behaviors.” Dr. Degotardi joined clinical psychologist Diana G. Fox, PsyD, also of Queens College, to lead the session titled “Improving Sleep: Non-Pharmacological Strategies” at the ACR/ARHP Annual Scientific Meeting in Boston last November.
The consequences of chronic insomnia can be debilitating. In one 2005 study, Dr. Fox points out, patients with chronic insomnia had problems performing tasks that measured vigilance, working memory, and motor control. Moreover, they self-reported negative moods and difficulty concentrating. A meta-analysis of studies that used subjects who were sleeping less than five hours a night on a regular basis found that these people had decreased glucose tolerance, increased blood pressure, reduced levels of leptin (an appetite-reducing hormone), and increased inflammatory markers. For those subjects who had poor sleeping patterns for six years or more, the study found a 15% increase in all-cause mortality—even after they had controlled for other risk factors like blood pressure and body mass index.
Identify Causes of Sleeplessness
Rather than focusing on the unfortunate consequences of chronic sleeping problems, the two experts stress treatment strategies. “The first step is assessing what exactly the sleeping problem is,” says Dr. Degotardi. The most effective way to do so, she adds, is with a thorough clinical interview. Doctors should ask these patients about their daily routine and typical sleep schedule—when they get to bed, when they wake up, how many naps they take, and whether any of this shifts dramatically on the weekends. They should ask how long it typically takes to fall asleep, if patients have frequent awakenings during the night, and if they can fall back to sleep after these disturbances.