Sleeping Pills Not Working? You May Be Treating the Wrong Condition

By Robert Rosenberg, DO

Over the years I have had thousands of

patients come to see me for insomnia. They are

frequently referred by other doctors or

healthcare professionals because, despite

taking medications, improving their sleep

habits, and trying cognitive behavioral therapy,

they still can’t fall asleep or stay asleep. In the

majority of cases, their healthcare provider is

at their wit’s end and has nothing left to offer.

When I am faced with a patient who has

“failed” all types of therapy, I frequently order

a sleep study. It is common for my request to

be met with skepticism on the part of the

patient, and this is not unexpected. The usual

response I get is, “I’m here for my insomnia,

doc, not for sleep apnea.”

The reason I order the sleep study is to rule

out an underlying sleep disorder that may be

the root cause of their insomnia. I am most

likely to order the study in the case of patients

whose insomnia is related to an inability to

remain asleep. I have always been impressed

by how many of these folks actually have a

sleep-related breathing disorder that is the

engine driving their insomnia.

Therefore, it was with great interest and just a

little self-satisfaction that I read a report in the

journal Mayo Clinic Proceedings. The

researchers studied more than 1,200 patients

referred to them over a seven-year period for

insomnia. The results were stunning: 899 of

the patients were taking over-the-counter or

prescription medications for insomnia. These

patients reported the most severe insomnia,

the fewest sleep-associated breathing

symptoms, and the most frequent incidence of

psychiatric or medical conditions. However,

when tested, 91 percent were found to have

sleep apnea!

The findings of this study are truly

revolutionary in terms of our approach to

severe insomnia. One problem may be that

screening tools used in primary care for sleep

apnea may not be sensitive enough. In fact,

the researchers found that a common

screening tool used in primary care practices

misclassified 32 percent of these patients as

not having sleep apnea when in fact they had a

high probability of having it.

How does sleep apnea cause insomnia? The

repetitive drops in oxygen and the stress of

attempting to breathe against a closed upper

airway are more than sufficient to awaken you

from sleep. The problem is that in most cases,

the person and their bed partner are unaware

of what brought them to this state. So if you

suffer from chronic insomnia that has defied

therapy, be open to the very real possibility

that sleep apnea may be the cause. In many

cases, a simple overnight sleep study may

allow you to get off medications that are not

working and never will.

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