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It is something all human beings do, regardless of where they live, how
they worship, or what they believe: They sleep.
Except that for a growing number of Americans, sleep has become
elusive.
Pat Foucht is 67-year-old, and lives in upstate New York. Eight years
ago, she developed breast cancer and underwent extensive medical
treatments. Ever since, her life has not been the same. "I'm just wide
awake all night long. And sometimes now, I'll have a wake-up and can't get
back to sleep. But it's mainly falling asleep."
Foucht is one of an estimated 60 million Americans who regularly suffer
from insomnia, either because they are taking medication, or experiencing
pain, or not eating right. Or - according to Russell Rosenberg, who
directs the Sleep Medicine Institute in Atlanta, Georgia - simply because
they are living in the modern world.
"It's a 24/7 society now. That is, you have Internet 24 [hours], 7
[days a week], television, radio. Everything can keep you distracted from
the time you need to sleep. Plus, people are working harder, working more
jobs, trying to squeeze in more family-time, more leisure-time and so
forth, and so there's only so much time to do all the things we want to do
in one particular day."
According to an annual poll conducted by the National Sleep Foundation,
in 2005, 75 percent of Americans experienced sleeping problems ranging
from minor and transient to severe and chronic. That is up from 62 percent
in 1999, when the NSF first conducted its poll.
The number of Americans turning to prescription sleep aids for help has
gone up even more dramatically: nearly 60 percent over the past five
years. American pharmacists filled about 42 million sleeping pill
prescriptions last year, and most of them were for either Ambien or
Lunesta, two recent additions to the sleep aid market.
These drugs are not believed to be habit-forming, and they don't seem
to have the same liver-damaging side-effects that earlier sleep aids had.
For that reason, Russell Rosenberg says they can be a good option for a
particular kind of patient. "For something we would consider very
short-term, or even transient. That is, let's say someone had a very
serious event in their life, a death of a loved one or something. In the
short-run, I think most physicians are going to realize this person just
needs a few tablets here and there to get them through the stress of the
situation."
At the same time, there is some evidence that these new sleeping pills
may not be completely harmless. Some people who have taken them have
reported having short-term amnesia. And Pat Foucht says she definitely
feels side-effects the morning after she's taken a prescription sleep
medication. "I do take something now when I have this problem, and I've
found that I'm groggy in the morning when I take it. And also I may be a
little bit more depressed."
For that reason, sleep experts prefer to treat their patients with what
is known as "cognitive behavioral therapy," or CBT. It is a form of
psychotherapy that tries to change the way a patient thinks, feels, and
acts about sleep.
It doesn't yield immediate results, though, and in many parts of the
country, it is unavailable. There are only about 200 clinicians worldwide
who have extensive CBT training in the area of sleep. That is part of the
reason prescription drugs have become so popular.
But the biggest reason, says Gregg Jacobs, an assistant professor of
psychiatry at Harvard Medical School, is marketing. "You'll see their ads
every night on television now. They're the most frequent drug ads on TV.
As a result, people around the United States - and soon around the world -
are being given the message that you can take a sleeping pill, and it will
cure your insomnia. And when people hear that, they rush out to buy this
pill."
Last year, drug companies spent more than $300 million on ads for
prescription sleep aids. That is more than four times as much as they
spent in 2004.
But Gregg Jacobs has unveiled his own weapon in the battle against
insomnia. It is an interactive website, cbtforinsomnia.com. Patients sign
on and have regular telephone and Internet consultations with a trained
clinician who could be two or 2,000 kilometers away. Results from a study
funded by the National Institutes of Health indicate that Internet-based
CBT may be more effective than prescription medication, or even
face-to-face therapy when it comes to treating insomnia.
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