The death risk is even higher -- over seven times the normal death rate -- for insomniacs with underlying diabetes or with high blood pressure, find Penn State researchers Alexandros. N. Vgontzas, MD, and colleagues.
Increased death risk was seen only in self-described insomniacs who, when tested in a sleep lab, slept less than six hours a night. People who said they did not have insomnia but who slept less than six hours a night did not have a significantly increased death risk. Neither did self-described insomniacs who slept more than six hours in the lab.
The findings come only from the men in the study. What about women? The jury is still out. The researchers began studying women five years after they began studying men. And since women tend to live longer than men, final results for women are not yet in.
"This is a very important study," sleep expert Lisa Shives, MD, medical director of Northshore Sleep Medicine, Evanston, Ill., tells WebMD. Shives, a spokeswoman for the American Academy of Sleep Medicine, was not involved in the Vgontzas study.
New Insomnia Treatments Needed
Shives notes people with insomnia tend to be in a constant "flight-or-fight" stress mode.
"We are supposed to have seven or eight hours every night with the body in a quiescent mode," she says. "Our heart rate, our blood pressure is lower, our sympathetic nervous system -- the flight-or-fight system -- all that is supposed to be dampened down. But think of someone who is unable to get this, who is under all this cardiovascular stress. We call that insomnia."
Vgontzas and colleagues study enrolled 1,741 randomly selected men and women. All study participants had to spend a night in the sleep lab, where their actual sleep duration was measured. They found that not all self-described insomniacs actually sleep less than normal people -- and that not all normal people who sleep less are insomniacs.
But their main finding was that insomnia sufferers who sleep poorly in a sleep lab are at significantly increased risk of illness and death.
"For all these years people have considered insomnia as a nuisance, as a problem of the 'worried well,'" Vgontzas says. "But this study shows that what we are talking about is a real and credible health problem."
Shives fully agrees with Vgontzas on this. She notes that some people with insomnia actually sleep better in a sleep lab, or in a hotel, than they do at home. Those who sleep poorly in the lab, she suggest, may represent a particularly high-risk subgroup.
Shives and Vgontzas agree on another thing: Contrary to popular opinion, insomnia is very difficult to treat.
"The current treatments available for insomnia are very, very limited," Vgontzas says. "We really have to increase our efforts to find new treatments. I know every drug company advertises its sleeping pill, but these medications are good for only a little while. Insomnia lasts for a long time. Our patients are frustrated with us, and we are frustrated with lack of success."
"The dark side of the moon is we don't understand insomnia very well and we treat it worse," Shives says.
"The pills don't get most people seven or eight hours of sleep. At most they get six. A whole subset of patients immediately feels bad when they take these drugs. And then there are insomniacs for whom they seem like miracle pills, until they take them for a year and they don't work anymore."
Shives says people with insomnia suffer a real physical illness. But for patients who get no relief from medication, she often recommends cognitive behavioral therapy (CBT) with a qualified psychologist.
"Over two to four years, CBT is more effective than medications," she says. "But still, this means taking people with a bona fide physical problem and teaching them these psycho-emotional tools to try to control their bodies. Insomnia is truly a mind-meets-body disorder."
The Vgontzas study appears in the Sept. 1 issue of the journal Sleep.