Insomnia Insomnia

16 Attarian
communities. A structured diagnostic assessment of psychiatric disorders as well
as assessment of the presence of insomnia not due to medical conditions, medication,
drug, or alcohol abuse, and a 1-year followup were completed. The results
revealed that 8% of subjects with primary insomnia had sought psychiatric help at
the end of that year for different psychiatric problems vs 2.5% of the normal controls.
Uncomplicated or primary insomnia was also associated with an increase in
risk for first onset of major depression, panic disorder, and alcohol abuse over the
following year (54). Other studies have confirmed these findings that insomnia is a
risk factor for the development of major depression (60).
Other disorders associated with untreated insomnia include alcohol abuse and
relapse into alcoholism (61,62), panic disorder (54), and possible coronary artery
disease (in men) (63).
Insomnia per se, however, is not a cause of increased mortality (60,64). Kripke
et al. surveyed and followed 1.1 million subjects for 6 years. Insomnia alone was
not associated with increased mortality. There was a suggestion that 8 or more
hours of sleep and sleeping pill use is associated with a slight increase in mortality
but no causality was determined (65). There is new evidence, however, that there is
an association between difficulties falling asleep and mortality due to coronary
artery disease in men (63).
There are a number of studies that have demonstrated decreased quality of life as
a direct result of the insomnia. Chevalier and colleagues, using SF-36 scores demonstrated
the degree of impairment in quality of life was directly related to the
severity of insomnia. They also demonstrated that individuals with severe insomnia
showed a higher level of health care consumption (36). Hajak and the Study of
Insomnia in Europe group in Germany and Leger and colleagues in France reported
very similar results regarding quality of life and health care consumption (33,66).
Zammit et al. and Hatoum et al., independently, reported similar results in the
United States (67,68). Cognitive deficits identified on objective testing have been
associated with chronic persistent insomnia as well (69,70).
EPIDEMIOLOGY OF HYPNOTIC USE
The use of hypnotics has been generally low among people reporting insomnia.
In the landmark study in the United States in 1979, Mellinger reported the use of
any kind of hypnotic medication to be only 15% and only 2.6% of insomniacs used
prescribed hypnotics (2). In 1998, Johnson et al. reported similar numbers; 18%
were using hypnotic medication, suggesting that there has not been a significant
change in the use of hypnotics over a period of 11 years (71). Other countries report
similar statistics in the use of hypnotics. Lopez et al. reported that only 10.5% of
insomniacs in Mexico used hypnotic medication (13). Sweden (72), Finland (15),
Great Britain (73), Australia (74), and France (3,75) reported similar numbers. Use
of hypnotics increases with age, particularly among middle-aged and elderly women
(75,76). Sleeping pill use varies with the person’s occupation also. According to
one study, male gardeners, female social office workers, and male construction