Public Health Concern: Medicating Sleeplessness

Here is an extraordinarily interesting article in The American Journal of Health from August 2011 titled, “The Medicalization of Sleeplessness: A Public Health Concern.” What I find most interesting is the way the article draws a distinction between insomnia and sleeplessness. Here is the article abstract:

Sleeplessness, a universal condition with diverse causes, may be increasingly diagnosed and treated (or medicalized) as insomnia. We examined the trend in sleeplessness complaints, diagnoses, and prescriptions of sedative hypnotics in physician office visits from 1993 to 2007. Consistent with the medicalization hypothesis, sleeplessness complaints and insomnia diagnoses increased over time and were far outpaced by prescriptions for sedative hypnotics. Insomnia may be a public health concern, but potential overtreatment with marginally effective, expensive medications with nontrivial side effects raises definite population health concerns.

Further down, the article address the issue of possible over treatment more specifically:

It is unclear … if the United States is facing a true insomnia epidemic or a surplus of diagnoses and drug prescriptions. … Awareness raised by public health and pharmaceutical agencies may facilitate new diagnoses. Medicalization may also contribute to the increased perception, diagnosis, and treatment of sleeplessness as the medical condition insomnia.

This situation within the medical community is precisely what In Pursuit of Sleep is intended to address. If insomnia is a medical condition and sleeplessness is a behavioral issue, insomnia should be treated with medication and sleeplessness should not. If sleeplessness is diagnosed as insomnia, the wrong treatment can be prescribed and actually harm the patient.

The big problem, of course, is that we don’t have an effective treatment for sleeplessness. The reason for this is that the medical profession and scientific research community are not addressing what is going on within the mind during the transition from being awake to being asleep that is causing sleeplessness. Here is a quote from In Pursuit of Sleep (pages 16-17), which includes a reference that fully explains the situation:

The strange thing is that, although hypnagogia [sleep onset] has been studied, it is rarely, if ever, addressed when discussing insomnia. Yes, you read that right. When professionals deal with the problems of getting to sleep, they rarely if ever discuss the nature of the transition state and how to deal with it.

…we know neither why nor how we fall asleep. The study of sleep has for the most part focused on measures obtained during established sleep, and many of the events and phenomena of sleep onset have been ignored. [Sleep Onset, Normal and Abnormal Processes, edited by Robert D. Ogilvie, PHD and John R. Harsh, PhD, Washington DC: American Psychological Association, 1994, page xviii]

Again, researchers are focused on the physics and chemistry of brain function during sleep because they are developing medication to put you in that state, and they specifically exclude the subjective personal experience of sleep onset (hypnagogia). This is incompetence on a colossal scale. It is difficult to understand how this could be happening without conscious disregard for the origin of the sleeplessness problem because to do so would result in behavioral solutions that would cut into the profits of pharmaceutical companies, perhaps putting some of them out of business. This situation is intolerable and In Pursuit of Sleep is intended as a first step in remedying this situation.