For those of us with artistic temperament and potential, lack of sleep has been traditionally associated with creativity. Walt Whitman, Emily Bronte and Marcel Proust often wrote during white nights. Balzac kept himself writing over sixteen hours a day overdosing on black coffee.
A modern artist named Kira Ayn Varszeg, created a series called “Insomnia” inspired from prolonged sleep deprivation. Unfortunately though, for the vast majority of us, insomnia is a hassle lacking any benefits.
Insomnia is the most common sleep disorder in adults, with a prevalence of about 10% and has significantly been associated with stroke, obesity, hypertension, and other medical and psychiatric disorders. When Balzac died at age 51, and this was attributed to coffee intoxication, the diagnosis might have not been that much off. Recently, sleeping less than 6 hours per night has been associated with a significant increase in mortality. In young healthy children aged 6-36 month the prevalence of insomnia is 8% and it coexists in the vast majority of cases with feeding disorders diazepam sin receta.
The studied impact on the society of insomnia is tremendous, although only partially understood. In a recent European study, about 30% of healthy adults reported waking up 3 or more times a night and in 80% of the cases the symptoms persisted longer than a year, with significant functional impairment. Frequent nocturnal awakenings were also shown to be associated with organic and psychiatric disorders.
For such a ubiquitous problem it is disappointing to find out how inefficient the medical and the paramedical field are in coping with it.
A variety of herbal and naturalistic remedies, body manipulations, over the counter medicines, drugs, prescription medications and even general anesthetics have been used to induce and maintain sleep. While weird geniuses like Nabukov believed in the positive influences of sleeplessness, for the general population the combination of white nights and fatigued inefficient days makes people willing to try various proven and unproven remedies.
An estimated 1.5 million adults in the US use some form of complementary medical approach for insomnia. More than double this number use sedative prescription drugs.
A recent review of the alternative medicine remedies for insomnia proves that most of them are useless (Clin Geriatr Med. 2008 February; 24(1): 121-viii.).
A large meta-analysis (AHRQ Publication No. 05-E002-2.) of melatonin use for sleep concluded that melatonin produces an insignificant decrease in sleep latency in primary insomnia with no improvement in sleep efficiency and no benefits in secondary insomnia. The good news are that melatonin is largely devoid of side effects making it a safe way of spending money (unlike cars, food or other unprotected activities).
Valerian, by itself or as part of various over the counter remedies, shares a similar lack of objective efficiency with melatonin but at different price and taste.
Not unexpected, mind body solutions are an effective mean of improving sleep, associated insomnia symptoms, mobility and the bank accounts of various providers and organizations, although there appears to be a definite lack of correlation between cost and duration of treatment.
One of the new trends in insomnia treatment recently gained traction it New York and the rest of the world. A Russian scientist converted brain’s electric activity into music using a proprietary algorhythm (Neurosci Behav Physiol. 1998 May-Jun;28(3):330-5).
Listening to the personalized ethereal music created by one’s own neurons had improved sleep in over 80% of the study group.
The success of the “brain music” in the New York area prompted the use of brain music therapy in other facilities around the country.
The medical treatment of insomnia is expertly guided by the American Academy of Sleep medicine with guidelines that “are not a practice parameter” and based upon the scientific understanding that “the empirical database for long-term treatment remains small”.
Most common prescription medications for insomnia are Clonazepam, Zolpidem, Trazodone, Alprazolam, Eszopiclone, Escitalopram, Temazepam, Zaleplon, Bupropion, Diazepam, Venlafaxine, Lorazepam, Sertraline, Flurazepam, Paroxetine, Fluoxetine, Amitriptyline, Olanzapine and Haloperidol (Prim Care Companion J Clin Psychiatry. 2010; 12(4): PCC.09m00873).
Not only is the use of medications in insomnia loosely regulated and incompletely understood, it is also inefficient and associated with possible abuse. Over 70% of the patients attribute the lack of efficiency of the medications to their incompetent doctor and not to the intrinsic limitation of a pharmacologic approach.