Unmet Needs in the Management of Insomnia


A brief review of the unmet needs in insomnia management, particularly access to treatment and daytime functioning.


Michael J. Thorpy, MD: We’ve talked a lot about insomnia, the symptoms, the diagnosis, and all the different treatment options. But looking to the future, what do we need to do? Vikas, what are the unmet needs for insomnia? What needs to be done to move the management of insomnia further ahead, do you think?

Vikas Jain, MD, FAASM, FAAFP, CCSH, CPE: I think we’ve discussed many of the limitations and the difficulties we all have in treating insomnia. The No. 1 guideline by the ACP [American College of Physicians] and American Academy of Sleep Medicine is to use cognitive behavioral therapy. However, access is limited. We don’t have as many trained behavioral sleep specialists that exist in our communities. That’s hopefully going to change in the future with more access, or even more online programs that can be beneficial. As Nate mentioned, many of these agents have traditionally just been measured by their ability to improve sleep onset or their ability to help a patient stay asleep at night, but not necessarily what influence they’re having on the day, or adverse effect profile. I also think access to medications can be an issue as well. As Karl had mentioned, with the American Geriatric Association, there are these medicines that they do not recommend using in the elderly population. But then sometimes many of the medicines that are recommended are cost-prohibitive for those patients as well. Thus, how do we continue to improve access to patients and have better medications hopefully available to use in the future to help treat this condition?

Nathaniel Fletcher Watson, MD: Michael, as asleep physicians, we hardly ever think about the sleep environment. We never think about beds, or mattresses, or other things such as that. And I think that as we look to the future, we can see that our technological advancements are going to create sleeping environments that are going to be more conducive to sleep for the individual. It’s going to tailor a sleep environment to the individual. Thus, whether that’s the temperature in the bed or in the room, whether it’s the firmness of the mattress, depending on body position, because you might need a less firm mattress when you’re on your side than you do when you’re on your back. Whether it’s lifting the head of the bed, if snoring is present, to help address some sleep apnea-related issues; whether it’s generating a light when you step out of bed so that it reduces the risk of falls in patients who are at risk for that. I think that there are a lot of things that are going to happen out there that are going to improve the sleep environment for people, which hopefully will have a positive effect on insomnia.

Transcript edited for clarity.

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