Insomnia is the most common sleep disorder. Approximately 25% of the adult population suffer from sleeping problems, and as many as 10% reach the threshold of insomnia. Insomniacs experience difficulty falling or staying asleep, a lack of restorative sleep, and daytime symptoms such as fatigue, mood disturbances and difficulty concentrating.

Despite the widespread use of over-the-counter products, such remedies have not been rigorously studied and there is little evidence to indicate which drugs, if any, work well and for whom.

For insomniacs, theirs is often a chronic condition. Nearly 70% continue to experience symptoms a year later, and half still have insomnia up to 3 years later. Compared to the general population, people with insomnia are more than five times as likely to experience anxiety and depression, are at more than twice the risk of developing congestive heart failure and diabetes, and may have an elevated risk of death. Insomniacs may also be at significantly greater risk of alcohol and substance abuse.

But despite the large number of people affected, insomnia often goes unrecognized and untreated. "In view of the high prevalence and substantial morbidities of insomnia, patients should routinely be asked about sleep problems by health care providers," say the authors of a new review paper about chronic insomnia.

According to these experts, much more needs to be done to identify and treat insomnia early in its development. Furthermore, efforts must be made to ensure that patients are treated according to clinical guidelines and with treatments of proven effectiveness. Some of the most commonly prescribed drugs, notably antidepressants and antihistamines, have been poorly studied for treatment of insomnia and are not approved for this condition. The problem is more pronounced for nonprescription drugs. Despite the widespread use of over-the-counter products, such remedies have not been rigorously studied and there is little evidence to indicate which drugs, if any, work well and for whom.

The U.S. National Institutes of Health (NIH) emphasizes that only two treatments – cognitive behavioral therapy (CBT) and hypnotic drugs cleared by the Food and Drug Administration (FDA) for use in insomnia – have been adequately studied and proven effective.

CBT uses psychological and behavioral methods such as relaxation techniques, sleep restriction, stimulus control and education about sleep-related lifestyle factors such as diet, exercise and the bedroom environment. CBT has been shown to be highly effective at treating insomnia, has no adverse side effects, and has long-lasting benefits, which is a clear advantage compared to drug treatment.

The review's authors conclude that there is an urgent need for more public education about insomnia and proven therapies, as well as for improved training of health care practitioners to recognize and treat insomnia according to evidence-based clinical guidelines.

More information and resources about sleep disorders are available from the American Sleep Association.