Lab Notes #17: Better Living Through Sleeping: A New Treatment for Insomnia

‘Tis the season for New Year’s resolutions! And, if you are one of the 80 million Americans who suffers from some sort of sleep disorder, there’s a new better-living-through-chemistry option to help you attend to your commitment to better living through better sleeping. 

First, a primer: the two big types of insomnia.

  • onset insomnia: difficulty falling asleep at the beginning of the night
    • key term in sleep studies: “sleep onset latency,” which is the amount of time it takes you to go from being fully awake to sleeping 
  • maintenance insomnia: The inability to stay asleep
    • key term in sleep studies: “sleep fragmentation,” which refers to the number of times you awake in the night

With New Year’s Eve festivities (which often include alcohol), remember how alcohol affects latency and fragmentation: “Although alcohol shortens sleep latency, it can lead to multiple awakenings throughout the sleep cycle (sleep fragmentation)” (here). Alcohol can also prevent you from slipping into deep sleep (stage 5), the most restorative phase of sleep in terms of feeling rested. It’s also a cruel, deceptive mistress — or master, take your pick: ““People who drink alcohol often think their sleep is improved, but it is not,” says addiction specialist Scott Krakower, DO. 

Okay: if you haven’t nodded off yet, let’s get back to the subtypes of insomnia.

  • acute insomnia 
    • symptom: extended latency or fragmentation or both
    • no worries: it’s probably just because you’re worried about something fleeting 
  • chronic insomnia: a long-term pattern of difficulty sleeping
    • symptom: regular struggle with extended latency or fragmentation or both
    • go ahead and worry: and talk to your doctor
  • comorbid insomnia: insomnia that occurs with another condition
    • again: talk to your doc; they can help you devise a manageable way to address your symptoms

The problem: Most “of the pharmacologic agents indicated for the treatment of insomnia  … are γ-aminobutyric acid agonists” — or, with benzodiazepine receptor agonists — which pose significant risks for older adult users.

A Jedi-like new hope: an investigative study out this week (here, commentary here) reviews a new class of pharmacologic agents, “dual orexin receptor antagonists,” which hold:

  •  “the promise of greater efficacy” in terms of addressing the failure to inhibit wakefulness” (hey fragmenters!), and 
  • “the potential for reduced adverse effects” (think: cognition, memory, motor functions). 

So, the objective analysis of sleep latency and fragmentation show positive signs, but the commentary includes food for thought of Dagwoodian proportions (also a bad idea before bedtime): 

Objectively measured improvement, in the absence of perceived improvement, is tantamount to no improvement. For example, consider chronic pain …  it is the patient’s experience of pain and treatment-related diminution of pain that is paramount. The same is true for insomnia.

The old call for the tri-partite day: 8 hours of sleep, 8 hours of work, and 8 hours for what we will. We long imagined the question of “what we will,” and wrung our hands, too, over the nature of work. Today, with all that science can offer, we’re making our best educated guess as to how sleep actually works. 

Thanks for stopping by, and happy new year!

 

Published by Randal Doane

Living the good life in NE Ohio. I dig science and the written word. Let's build something amazing together.

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