Insomnia is considered chronic when it lasts most nights for a few weeks or more. This longer-term condition deserves professional attention, says Tom Roth, Ph.D., head of the Sleep Disorders and Research Center at Henry Ford Hospital in Detroit. If you’re unsure about whether you have chronic insomnia, Roth suggests looking at it like a headache. “If it goes on day after day and nothing you do makes it go away, then you should see a doctor,” he says. “Ask yourself: Do you know the cause?”
Sometimes insomnia is caused by an underlying illness that needs treatment, such as a thyroid disorder, anxiety, depression, arthritis, or asthma. Georgi Moyer, 60, of Gaithersburg, Md., has had problems with insomnia for 38 years because of restless leg syndrome, a condition that causes tingling and crawling sensations in the legs. “It feels like ants crawling around inside your legs,” says Moyer. “The only thing that helps is moving your legs. So I end up pacing the floor or kicking my husband in bed.”
Moyer, who is a nurse, chooses to work nights because her problem is at its worst from about 8 p.m. until 3 or 4 in the morning. There are no drugs approved by the FDA for restless leg syndrome. Moyer says she has found some relief with drugs that treat symptoms of anxiety.
For others, the cause of insomnia may be a combination of factors and hard to pinpoint. Mike Shockey, Ph.D., 52, of Stafford, Va., has had a severe case of insomnia for 30 years. There have been times when he’s slept only 15-20 hours during a week. A sleep test indicated that he hasn’t been reaching the deepest–and most restorative — stages of sleep for years.
As a result, Shockey has felt both the mental fog and a physical slowdown from sleep deprivation. “Sometimes, my legs have felt like stone,” says Shockey, who is a college professor and novelist. “I’ve had to hold onto the podium to stay up. Or I might drive somewhere and sit in my car for awhile because it’s a huge effort to get across the parking lot.” He says he’s often jealous of his wife. “She falls asleep soon after she hits the pillow and I look over and think — it sure must be nice.”
About 85 percent of people who have insomnia can be helped with a combination of behavioral therapy and medicine, says Marc Raphaelson, M.D., a neurologist with the Greater Washington Sleep Disorders Center in Rockville, Md.
Prescription hypnotic drugs act in areas of the brain to help promote sleep. There have been advances with the development of more short-acting drugs to decrease drowsy spillover effects in the morning. Sonata (zaleplon), for example, is a drug designed to help you fall asleep faster, but not for keeping you asleep. Ambien (zolpidem) is an example of a drug indicated for both getting to sleep and staying asleep.
Insomnia has traditionally been viewed as a symptom of an underlying medical or psychiatric illness, and drugs to treat insomnia are approved for short-term use only, until the primary condition can be treated.
Hypnotic drugs are potentially addictive. Generally, their use is limited to 10 days or less, and the longest that they are approved for use is about 30 days, says Paul Andreason, M.D., a drug reviewer in the FDA’s Division of Neuropharmacological Drug Products. “Drug sponsors have not done longer-term studies that evaluate the drugs’ effectiveness for longer periods,” he says.
Raphaelson says there is a gap in approved treatments because some people with this chronic condition may need long-term treatment. About 20 percent of people with chronic insomnia have a primary form of it, which means it’s not associated with another medical condition.
“Most people I’ve seen are frightened of the medications for fear of addiction,” Raphaelson says. “But there is little indication that people with insomnia abuse these medications.”
As with any prescription medication, it’s important to not increase doses or stop taking hypnotic drugs without consulting a doctor. No drugs that promote sleep should be taken with alcohol. And because of the sedating effects, caution must be used when getting out of bed, driving, or operating other machinery.