By John Scott

Perhaps I am growing more cynical, but every time I see a new piece of research only lasting one or two years, I wonder why it stopped early. I suppose it is always a balancing act. If you have a specific hypothesis, evidence for or against should be apparent fairly quickly. Thus, if a company believes it has the new blockbuster drug, administering it to some brave volunteers should produce good results or lose credibility in months. Anyway, the longer a trial goes on, the more difficult it gets to distinguish between potential causes and their effects. So when one or two participants develop a heart condition or get depressed, is this a side effect of the medication under test or a coincidence? In many cases, the answer only emerges over time. But no-one is systematically collecting longitudinal data. This is very convenient for the manufacturers which might have to pull a medication from the market if adverse evidence emerged. This leaves a moral question: who puts a value on one or two lives lost when millions may be benefiting from the medication? Anyway, I am inspired by a study published in this month’s Sleep which, unusually, collected evidence over twenty years. Long-term studies like this should be the norm when human health and lives are at risk. This research in Switzerland took a sample of just under six hundred young adults who were suffering from moderate to severe insomnia. This was a study of insomnia itself and not of any medication used to treat it. The study shows that most of the group found the insomnia growing steadily more pronounced as the years passed. You might wonder why they were not all given ambien or an equivalent. The answer, of course, is that they were and to excellent short-term effect. But these powerful medications are only used in moderation and not over long periods of time. Further, the medications are not cures in the literal sense of the word. They merely give relief during which time those who suffer may attempt to relearn the art of sleep. Thus, even though ambien and other sleeping pills produced the promised sleep artificially, the majority of participants could not recapture the natural sleeping patterns of their youth. Curiously, women were more at risk of insomnia patterns stabilising and expanding. More worrying was that about 35% of those who had episodes of insomnia lasting more than two weeks subsequently suffered a major depressive disorder. The study concludes that insomnia is persistent and increases the risk of depressive conditions. This leaves me with three ad hoc conclusions: • once formed, the habit of not sleeping the usual seven or eight hours a night can be hard to break — only cognitive behavioural therapy or counselling can modify habits over the long term; • ambien can only be used to provide temporary relief because of the risk of dependence. But this use is necessary. Without ambien, a persistent insomniac’s health is damaged more quickly and more seriously; and • the disruption to sleep patterns is more closely linked to depression — as the medical profession is wont to say, they are comorbid conditions. The final thought has to be that if you are unlucky enough to suffer from insomnia, take ambien as directed by your doctor and work intensively with a therapist or counsellor. The combination is the best chance of avoiding long-term problems.

Submitted By JohnScott

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