WHEN ARE SLEEP problems part of the human experience, and when are they pathological? Can hypnotics help chronic insomnia? Do patients develop tolerance and dependence? Which behavioral strategies work best, and what improves patient compliance? These and other clinical controversies in insomnia kept audiences wide awake at this year's joint annual meeting of the American Sleep Disorders Association and Sleep Research Society in San Francisco, Calif.
Some 27% of 26 000 primary care patients in 15 countries reported that they experienced persistent insomnia in a recent World Health Organization study. Insomnia is a broad term that encompasses trouble falling asleep or staying asleep and the perception that sleep is not refreshing or restorative. Its daytime consequences include diminished alertness, concentration, and memory, as well as depressed mood. About 1 in 10 persons claims to have suffered insomnia most nights or every night for 1 month or longer, and thus is