Intended for healthcare professionals


Treating insomnia

BMJ 2004; 329 doi: (Published 18 November 2004) Cite this as: BMJ 2004;329:1198

BMJ 110 years later ....

Holbrook's editorial although presumably prompted by the NICE report was immediately reminiscent of one written in the BMJ 110 years ago:
"The subject of sleeplessness is once more under public discussion. The hurry and excitement of modern life is quite correctly held to be responsible for much of the insomnia of which we hear: and most of the articles and letters are full of good advice to live more quietly and of platitudes concerning the harmfulness of rush and worry. The pity of it is that so many people are unable to follow this good advice and are obliged to lead a life of anxiety and high tension. Hence the search for some sovereign panacea ... "

Whilst that editorial predated barbiturates it does seem to resonate a little with the notion that a panacea like 'cognitive behaviour therapy' might not be? The older editorial continues: "There can, however, be no doubt that different remedies suit different cases." And that's an important problem - insomnia is not a single entity and unless one bludgeons the brain into submission there are no panaceas nor simple outcome measures and sadly nor are there likely to be with the current economic and regulatory controls of medicines. What may be needed is: 1) a better classification of 'insomnia,' and 2) why do patients who do not become tolerant find sleeping pills nice?

Whilst the NICE review did its best the fundamental problem is that imperfect outcome variables are used to measure a heterogenous condition, which probably leads to lack of discrimination between treatments.

One pernickety point: surely it should be 'z' drugs not 'Z' drugs. Isn't the convention to have generic names lower case and trade names to be capitalised?

  • SEPT. 29, 1894 Page 719 The British Medical Journal - Sleeplessness

Competing interests:
Hard to know which: have worked for most organisations involved, written books on insomnia, contributed to NICE evaluation, etc.

Competing interests: No competing interests

23 November 2004
Chris Idzikowski
Dromore, BT25 1QN, Lisburn and London.