INSOMNIA WATCH

Insomnia Linked with Chronic Diseases

Chronic insomnia often accompanies chronic diseases such as arthritis, cardiovascular disease, and diabetes. An article in the May 2006 supplement to The American Journal of Managed Care characterized the insomnia that coexists with these and other chronic physical and psychiatric conditions.

Insomnia is typically more prevalent, severe, and persistent in individuals with chronic illness, compared with healthy individuals or those experiencing nonchronic illness. In general, those with chronic illness tend to report more problems with sleep maintenance than with sleep-onset latency. The types of sleep difficulties associated with a particular chronic disorder tend to be similar, but they vary greatly between different chronic diseases.

Comorbid insomnia often has an inordinate impact on quality of life and daily functioning in those with chronic disease. Successful treatment of the underlying condition may result in healthier sleep; however, treatment of sleep dysfunction is not guaranteed to improve the chronic disorder.

Few studies have directly assessed the sleep problems associated with chronic disease. The author of the article recommended further research to fully understand chronic, comorbid insomnia and illness and how to optimize treatment of both.

Benzodiazepines Are Effective for the Elderly

Research published in the Journal of Clinical Pharmacy and Therapeutics (April 2002) assessed the efficacy and safety of treating insomnia in older adults, both during and after their hospital stays. In the hospital setting, 94% of the prescriptions for insomnia were for temazepam, which was one of 3 benzodiazepines prescribed. These agents proved particularly effective in the hospital for reducing patients' mean sleep latency and number of awakenings. Temazepam improved sleep in previous benzodiazepine patients as well as in benzodiazepine-naive patients.

Patients treated with temazepam did not experience significant daytime sedation, a common side effect of some medications for insomnia. Finally, patients did not become reliant on temazepam: inappropriate outpatient use of these drugs was not reported in the postdischarge patients. The study confirmed that benzodiazepines such as temazepam are effective and safe options for relieving insomnia in the elderly in the hospital setting, without great risk of inappropriate use in the posthospital environment.

Stop Watching the Clock

Studies have suggested that worrying may contribute to subsequent difficulty falling asleep or maintaining sleep. A number of common presleep activities, such as watching a clock or monitoring time, could potentially contribute to presleep worry.

The aim of research conducted in England and reported online June 20, 2006, in the Journal of Behavior Therapy and Experimental Psychiatry was to determine the impact of clock monitoring on healthy sleep patterns in young and middle-aged adults of both genders. In one experiment, the researchers found that both good and poor sleepers who watched a clock reported more presleep worry and experienced longer sleeponset latency, compared with those who did not use a clock.

In a second experiment, patients with primary insomnia who monitored a digit display unit experienced less worry and sleep interference than those watching a clock. The study demonstrated that presleep activities such as watching a clock may cause patients to worry more about sleeping and misperceive their sleep status?both of which may contribute to general sleep disturbance or insomnia

Poor Sleep Impacts Cognitive Ability

Insomnia, as well as other conditions that are associated with poor sleep, may negatively impact cognition, regardless of an individual's age. In older individuals, who experience more sleep difficulties and cognitive decline than the young, a link between insomnia and mental ability is emerging. A recent study of impaired sleep and cognition, reported in the journal Alzheimer Disease and Associated Disorders (January-March 2006), addressed this phenomenon.

The study focused on a group of >1800 American women aged =70 years who were given a battery of cognitive tests to assess any impacts attributed to sleep duration, snoring, or difficulty sleeping over a period of 2 years. The study found that women who slept =5 hours per night performed significantly more poorly on initial cognitive tests, compared with patients who slept 7 hours nightly. Self-reported difficulty falling asleep also translated into declining performance on the tests; however, snoring did not appear to negatively impact cognition.

A hypothesis for these results is that similar factors may influence both perception of sleep and selected cognitive abilities. The study confirmed a connection between sleep patterns and mental ability and may offer valuable insight into understanding dementia and other mental impairment in older adults.