Trouble Sleeping? New Treatment Options May Help

Nov. 23, 2015 -- Two out of five Americans regularly don’t get enough shut-eye. If you’re one of them, your health may be at risk.

“We now know that lack of sleep, insomnia, is likely to put you at greater risk of cardiovascular disease and high blood pressure,” says Alon Avidan, MD, MPH, director of the UCLA Sleep Disorders Center.

Research also links poor Zzz's with kidney disease, diabetes, depression, and obesity. Cancer and Alzheimer’s disease may also be tied to bad sleep. And of course, life’s simply harder to enjoy when you’re always sleepy. (Did we mention you’re also more likely to get a cold if you skimp on shut-eye?)

Advances in sleep medicine over the last year or so -- including research, technology, and a new breed of medication -- may help. While none may be magic bullets for tough sleep problems, these treatments give you more options if you need better rest.

“With insomnia treatment, it’s a lot of trial and error,” says sleep specialist Preethi Rajan, MD, of the North Shore-LIJ Health System in Great Neck, N.Y. It can take time and effort to find a treatment that works long-term.

Apps and Online Programs

New technology can help against insomnia.

“We tell patients that cognitive behavioral therapy (CBT) is the best way to treat chronic insomnia,” says Ketan Deoras, MD, of the Cleveland Clinic’s Sleep Disorders Center.

CBT counseling, or CBT-I for insomnia, helps address the habits that make sleep difficult, and it's based on your unique needs. But too few people have access to the treatment, because there’s a shortage of therapists, Deoras says. Smartphones and computers may help fill that gap with apps and online therapy

You can access programs like the Cleveland Clinic’s GO! to Sleep, CBT-i Coach, SHUTi, and others on your smartphone, tablet or computer. They're often free or low cost, and they save time you'd otherwise spend traveling to and from appointments. A recent study found that the online programs helped users get to sleep more quickly, and they said they slept better -- although they didn’t necessarily snooze longer.

“Programs like these have been around for a few years, but only recently has research started to show that they are effective,” Avidan says. He says they can work even if the program is a few weeks long.

You provide information about your daily habits -- such as how much coffee you drink, what time you turn off the TV -- and the program synthesizes your data and provides recommendations. It can then share your info with your doctor so you can work together.

Popular apps and devices that monitor sleep, such as the Fitbit, have yet to receive a great deal of scientific scrutiny, but they may also help, Rajan says.

“I think they’re incredibly promising, because they raise awareness of sleep issues, and they might help reach people who would not otherwise come in for an evaluation,” she says. “I often see patients who tell me, ‘My device says my sleep quality is not great, but I don’t know what that means.’”

Avidan says he expects sleep apps to become more and more useful in the coming years, both to help diagnose sleep issues and to better track how we sleep. Deoras warns his patients not to get too focused on what the apps tell you, though.

“Some insomnia patients are really hyper-focused on their sleep, and sometimes that can actually make the insomnia a little worse,” he says. “That focus ramps up their anxiety.”

A New Device for Sleep Apnea

Approved by the FDA last year, the Inspire system is an implantable device for people with obstructive sleep apnea who don’t do well with a CPAP device, the typical treatment.

“There’s a lot of buzz about this in the sleep community,” Rajan says.

Sleep apnea disrupts breathing throughout the night, which makes restful sleep harder and may contribute to serious health conditions like heart disease and high blood pressure. The system involves surgically placing an implant in your chest and neck. The device monitors your breathing and stimulates the nerve that controls the movement of your tongue, to keep your airways open throughout the night.

Rajan says it's been shown work for moderate to severe sleep apnea, but she warns that it has not been tested on obese people with a BMI greater than 32. (A 5-foot-6 woman weighing 200 pounds has a BMI of 32.3, for example.) According to the company’s web site, it’s not meant for people who are significantly overweight. Early trials found that patients with higher BMIs didn't do as well with the device as other people, says Quan Ni, PhD, Inspire’s vice president of research.

“That excludes a lot of patients,” Deoras says. Many of the estimated 18 million Americans with sleep apnea are overweight or obese.

In the 2014 study that looked into how well the device works, few participants said it gave them problems. But a small number found the electrical pulses uncomfortable, while others had tongue soreness and dry mouth. Two people required a follow-up procedure to reposition the device.

Its maker, Inspire Medical Systems, Inc., says the device costs about $20,000 plus the cost of the surgery to implant it. Your insurance company determines how much of that cost will be covered and how much you'll have to pay.

While a growing number of centers now use the device -- the company estimates 50 to 60 in the U.S. -- the technology is new and, for sleep specialists and surgeons, the learning curve is steep, Avidan says.

“This is an emergent technology, and the surgeon has to be fairly experienced in this operation,” he says. “There are not a lot of people who know how to do it.”

A New Type of Medication for Insomnia

Insomnia drugs have traditionally targeted the part of the brain that controls sleepiness. Stimulate that brain area, and you induce sleep. Belsomra does the opposite. The drug, approved last year, blocks the area of the brain that helps keep you awake.

But Consumer Reports analysts found that people who took Belsomra fell asleep only 6 minutes faster than those who took a sugar pill. By contrast, people who used the medicine zolpidem nodded off 20 minutes faster than those who took a fake treatment, or placebo. The bottom line for Deoras: “It’s something else to try if patients have gone through the typical insomnia medications and aren’t getting good results.”

Rajan agrees. “It’s so new, that I usually give it to patients only after they have been on everything else and have not been helped. There’s no way to predict which patients will respond to which medication.”

Belsomra also comes with its share of possible side effects, including hallucinations and feelings of paralysis while falling asleep or while waking. Deoras says that his patients have not reported such problems, nor does he consider the side effects to be worse than those of other insomnia drugs. He often hesitates to prescribe it for another reason: cost. Belsomra could cost up to $275 for a month’s supply, with a savings coupon.

“Patients I’ve prescribed it to have come back saying their insurance won’t cover it,” Deoras says. “The expense/insurance coverage is definitely difficult to deal with, and I don’t see it as dramatically better than other meds out there... I know the majority of sleep providers in our center aren’t prescribing it currently.”

Dr. Avidan speaks on behalf of Merck, makers of Belsomra.


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