Associated Press

WASHINGTON (AP) — Millions of Americans lie awake at night counting sheep — or have a stiff drink or pop an allergy pill, hoping it will make them drowsy. But experts agree all that self-medicating is a bad idea, and the causes of chronic insomnia remain mysterious.

Almost a third of adults have trouble sleeping, and about 10% have symptoms of daytime impairment that signal true insomnia.

Sufferers readily cite the resulting problems: walking around in a fog, as memory and other cognitive functions slow. Dozing off at the wheel or at work. Depression. Lack of energy.

But for all the complaints, scientists know surprisingly little about what causes chronic insomnia, its health consequences and how best to treat it, a panel of specialists brought together by the National Institutes of Health concluded Wednesday.

Two things are clear, the panel found: Chronic insomnia is a major public health problem. And too many people are using unproven therapies, even while there are a few treatments that do work.

The hope is that the report will dispel some of what panelist Dr. Sean Caples of the Mayo Clinic decried as "misinformation and myths."

Among the panel's findings:

• Cognitive/behavioral therapy — a psychology-based treatment that trains people to reduce anxiety and take other sleep-promoting steps — is very effective, and doesn't cause side effects. But it can be hard to find health providers trained in the techniques. Insomniacs should check with board-certified sleep specialists and psychologists.

• Newer prescription sleep pills called Sonata, Ambien and Lunesta work without many of the side-effect concerns of older agents known as benzodiazepines. One study of Lunesta showed effectiveness with six months of use, but more research on long-term use of all three is needed, as chronic insomnia can linger for years.

• The most commonly used treatments are alcohol and over-the-counter sedating antihistamines like Benadryl. Alcohol use actually disrupts quality sleep, and antihistamines can cause lingering daytime sedation and other cognitive problems.

• The most common prescription insomnia medicine is an older, sedating antidepressant called trazodone, even though there's no good evidence that it offers more than a two-week benefit, and it comes with side effects.

• There is no evidence backing the effectiveness of the popular dietary supplements melatonin and valerian to fight insomnia.

Self-medicating aside, why do even doctors reach for trazodone and other unproven treatments? The panelists suspect that some are reluctant to prescribe controlled substances, a category that includes prescription sleep aids.

That shouldn't be a concern with the newer pills, known as non-benzodiazepines, which come without the abuse potential of older sleep aids because they're eliminated from the body much faster, explained panelist Dr. Charles Zorumski, psychiatry chief at Washington University School of Medicine.

The panel called for a broad range of research into insomnia, noting that if scientists understood its underlying causes, they could develop better treatments.

Most, but not all, insomnia is thought to accompany other health problems, from arthritis and depression to cardiovascular disease. The question often is whether the insomnia came first or was a result of the other diseases — and how trouble sleeping in turn complicates those other problems.

"We know way too little about all those variables," said panel chairman Alan Leshner, chief of the American Association for the Advancement of Science.

Treating depression or restless legs syndrome, for example, could cure some people's insomnia without them ever using a sleeping pill, said Richard Gelula of the National Sleep Foundation, which praised the new report.

Other diseases aside, the risk of insomnia seems to increase with age and to be more common among women, especially after menopause. Smoking, caffeine and numerous prescription drugs also affect sleep.

The NIH is spending about 0 million this year on sleep-related research, some targeted to specific disorders and others examining the underlying neurobiology of sleep, said Dr. Carl Hunt, chief of the agency's National Center on Sleep Disorders Research. The agency was awaiting the panel's review before deciding what additional work should be directed at insomnia, he said.

"We need to take a fresh look at this," Hunt said Wednesday.

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