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Improved habits may lull insomniacs into better sleep.

PHILADELPHIA -- A population-based study of insomniacs and normal controls is the first to demonstrate that people who have insomnia frequently engage in more inappropriate sleep hygiene practices than do noninsomniacs, Catherine Jefferson said at the annual meeting of the Associated Professional Sleep Societies.

"The fact that the study is population based and not clinic based is important, because clinic populations are self-selected, and most insomniacs do not seek treatment," said Ms. Jefferson, a research assistant in the sleep disorders and research center at Henry Ford Hospital, Detroit. "Our study gives a good idea of what is actually going on out there and what is in need of addressing," she said.

In the study, a randomized phone outreach to 3,283 people in the Detroit tri-county area resulted in the identification of 258 primary or secondary insomniacs (based on DSM-IV criteria) and 258 age- and sex-matched people without insomnia (mean age 43 years; 62% female).

Insomnia criteria included experiencing severe difficulty getting to sleep, staying asleep, or having nonrefreshing sleep for at least 1 month.

Results showed that insomniacs had an increased frequency of smoking compared with controls (40.7% vs. 22.9%). Insomniacs also more frequently smoked within 5 minutes of bedtime (45.3% vs. 21.8%).

Insomniacs reported more overall alcohol use (4.7 vs. 2.3 drinks per week) and more use of alcohol for sleep (29.1% vs. 11.2%). Insomniacs more frequently used alcohol within 30 minutes before bedtime (12.9% vs. 5.6%). Both alcohol and cigarette use have been proved to negatively affect sleep and are established sleep hygiene targets, Ms. Jefferson noted.

Insomniacs also reported more compensatory sleep: They had a higher frequency of naps per week (3.5 vs. 2.7) and were more likely to sleep in on weekends (42.7% vs. 32.4%). Caffeine intake did not differ between groups (3.0 vs. 2.7 drinks per day), nor did hours spent in bed.

"Our results show that particular sleep hygiene practices such as smoking and alcohol use--especially before bed--and compensatory sleep may be more important treatment targets for insomniacs as compared to other inappropriate sleep habits," Ms. Jefferson said.

Established behavioral treatment regimens frequently employ a general component addressing sleep hygiene for insomnia patients.

But the results of this new study indicate that more attention needs to be paid to those specific problems rather than time spent in bed or caffeine intake, she noted.

The team at Henry Ford Hospital emphasized changing certain sleep behaviors as an alternative or complement to medication for an individual with chronic insomnia, Ms. Jefferson said.

"Sleep hygiene does not refer to complex behavioral interventions such as sleep restriction or stimulus control therapy, which require treatment from a sleep specialist. Sleep hygiene should be a part of all treatment plans in the same way that diet and nutrition are a part of the treatment of metabolic disorders," Ms. Jefferson said.

The study was supported by a grant from the National Institutes of Health.

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Title Annotation:Mental Health
Author:Mulcahy, Nicholas
Publication:Family Practice News
Geographic Code:1USA
Date:Sep 1, 2004
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