New approach recommended to treatement of chronic insomnia

[Guest Michelle]

New approach recommended to treatment of chronic insomnia

WESTPORT, CT (Reuters Health) Aug 14 - Chronic insomnia, unlike sleep deprivation, is associated with increased plasma levels of adrenocorticotropic hormone (ACTH) and cortisol, investigators report.

This finding suggests, they say, that the therapeutic goal in treating insomnia should go beyond improving the quality or quantity of sleep and should include a reduction in hyperarousal, which is a risk factor for both psychiatric and medical morbidity.

Dr. Alexandros N. Vgontzas, of Pennsylvania State University College of Medicine in Hershey, and associates monitored the sleep of 11 patients with insomnia and 13 control subjects without sleep disturbances. Blood was collected every 30 minutes for 24 hours.

The 24-hour mean ACTH secretion was significantly higher in the insomniacs than in the controls, 4.2 versus 3.3 pmol/L (p = 0.04), the researchers report in the August issue of the Journal of Clinical Endocrinology and Metabolism.

Cortisol levels were also higher among those with insomnia, 218 nmol/L versus 190 nmol/L in controls (p = 0.07), and insomniacs had a significantly higher number of ACTH and cortisol pulses than did controls.

Dr. Vgontzas' group proposes that the pathophysiology of chronic insomnia differs from that of sleep loss, with chronic insomnia being a disorder of hyperarousal present throughout the 24-hour sleep/wake cycle. The hypercortisolism is likely to lead not only to depression, but also to hypertension, visceral obesity, and osteoporosis, the researchers suggest.

"This information could help doctors who are treating insomniacs refocus their therapeutic goals," Dr. Vgontzas said in a prepared statement. "Instead of aiming to simply improve nighttime sleep, doctors may now work to decrease the levels of physiologic arousal."

Toward that end, medications that downregulate the activity of the hypothalamic-pituitary-adrenal axis, such as antidepressants, may be of greater therapeutic benefit than hypnotics, the investigators remark.

J Clin Endocrinol Metab 2001;86:3787-3794.