Health & Medicine
Losing Sleep
You stare at the ceiling. You try to ignore the clock. You consider your son's lousy report card. You avert your eyes from the clock. Your mind latches onto the next day's PowerPoint presentation. Too many bullets? Too few? Oops--you look at the clock. Aargh . . . even if you fall asleep right now, you're only going to get five hours of sleep. You'll be exhausted tomorrow, you'll lose your job, you won't be able to pay the mortgage, your kids will land on the street, and omigod, now it's only 4 1/2 hours.
Insomnia is nothing new. Cave men probably agonized about being too tired in the morning to catch a really good mammoth. But many sleep specialists suspect--no one can say for sure--that a world that offers TV, 24/7 interconnectivity, and boundless workdays is swelling the insomniac population. Insomnia increasingly is being viewed as a medical problem, drawing a new generation of pills and talk therapy. Sleep drugs claimed to be free of the grogginess and addiction risk of older potions are flooding the market, with more to come. And cognitive-behavioral therapy, widely used in other disorders, is being wielded against insomnia.
Insomnia isn't just an inability to fall asleep; it's more like an inability to sleep well. The classic insomniac lies in bed, wide-eyed, before managing to drift off. Another awakens during the night and can't go back to sleep, while still another snoozes straight through but wakes up unrefreshed. Insomnia may be linked to bigger health problems. Insomniacs are more likely to suffer from intractable, worsening pain, more likely to have accidents, and more likely to be diagnosed at some point with depression. And insomnia can indicate other health problems, such as sleep apnea.
Pill popping. Sleep drugs have joined Viagra, Botox, and other "lifestyle drugs" that target well-being rather than disease. In the first seven months of 2005, nearly 25 million prescriptions for sleep medications were filled, according to IMS Health, which tracks such statistics. And the number of adults ages 20 to 44 who took prescription sleep medications doubled between 2000 and 2004, according to a survey released this week by Medco Health Solutions, a manager of drug benefit programs. The market for the drugs should become even livelier as geared-up ad campaigns urge bleary-eyed consumers to bug their doctors.
Current sleep medications aren't as miraculous as their marketing suggests, but they're far superior to barbiturates--deadly when mixed with alcohol and with a low threshold for overdosing--and most sleep experts consider them improved over sleep inducers such as Halcion and Restoril that were introduced in the 1970s and 1980s. Those drugs boost the activity of a receptor molecule on the surface of brain cells, setting off a chain reaction that damps down brain activity and brings on sleep. They can make patients feel woozy and lose coordination, and are classified as controlled substances because of their potential to be habit-forming.
The newest drugs on the market--Ambien CR, Sonata, and Lunesta--affect brain chemistry the same way but are choosier about the receptors they target. Their side effects are generally milder than those of older drugs, and the risk of psychological dependence seems lower, but they are still classified as controlled substances. More such drugs are coming--Indiplon, for example, could be approved by the Food and Drug Administration and available by next summer.
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