It is something all human beings do, regardless of where they live, how they worship, or what they believe: They sleep.
Except that for a growing number of Americans, sleep has become elusive.
Pat Foucht, 67, lives in upstate New York. Eight years ago, she developed breast cancer and underwent extensive medical treatments. Ever since, her life has not been the same. "I'm just wide awake all night long," she says. "And sometimes now, I'll wake up and can't get back to sleep. But it's mainly falling asleep."
Foucht is one of an estimated 60 million Americans who regularly suffer from insomnia, either because they are taking medication, or experiencing pain, or not eating right. Or -- according to Russell Rosenberg, who directs the Sleep Medicine Institute in Atlanta, Georgia -- sometimes it is simply because they are living in the modern world.
"It's a 24/7 society now," Dr. Rosenberg notes. "That is, you have Internet 24 [hours], 7 [days a week], television, radio. Everything can keep you distracted from the time you need to sleep. Plus, people are working harder, working more jobs, trying to squeeze in more family-time, more leisure-time and so forth, and so there's only so much time to do the things we want to do in one particular day."
According to an annual poll conducted by the National Sleep Foundation, in 2005, 75 percent of Americans experienced sleeping problems ranging from minor and transient to severe and chronic. That is up from 62 percent in 1999, when the NSF first conducted its poll.
The number of Americans turning to prescription sleep aids for help has gone up even more dramatically: nearly 60 percent over the past five years. American pharmacists filled about 42 million sleeping pill prescriptions last year, and most of them were for either Ambien or Lunesta, two recent additions to the sleep aid market.
These drugs are not believed to be habit-forming, and they do not seem to have the same liver-damaging side-effects that earlier sleep aids had. For that reason, Russell Rosenberg says they can be a good option for a particular kind of patient. "For something that we would consider very short-term, or even transient," he says. "Let's say someone had a very serious event in their life, a death of a loved one or something. In the short-run, I think most physicians are going to realize this person just needs a few tablets here and there to get them through the stress of the situation."
At the same time, there is some evidence that these new sleeping pills may not be completely harmless. Some people who have taken them have reported having short-term amnesia. And Pat Foucht says she definitely feels side-effects the morning after she has taken a prescription sleep medication. "I do take something now when I have this problem, and I've found that I'm groggy in the morning when I take it. And also I may be a little bit more depressed."
For that reason, sleep experts prefer to treat their patients with what is known as "cognitive behavioral therapy," or CBT. It is a form of psychotherapy that tries to change the way a patient thinks, feels, and acts about sleep.
It does not yield immediate results, though, and in many parts of the country, it is unavailable. There are only about 200 clinicians worldwide who have extensive CBT training in the area of sleep. That is part of the reason prescription drugs have become so popular.
But the biggest reason, says Gregg Jacobs, an assistant professor of psychiatry at Harvard Medical School, is marketing. "You'll see their ads every night on television now. They're the most frequent drug ads on TV," he notes. "As a result, people around the United States-- and soon around the world -- are being given the message that you can take a sleeping pill, and it will cure your insomnia. And when people hear that, they rush out to buy this pill."
Last year, drug companies spent more than $300 million on ads for prescription sleep aids. That is more than four times as much as they spent in 2004.
But Gregg Jacobs has unveiled his own weapon in the battle against insomnia. It is an interactive website, cbtforinsomnia.com. Patients sign on and have regular telephone and Internet consultations with a trained clinician who could be two or 2,000 kilometers away. Results from a study funded by the National Institutes of Health indicate that CBT may be more effective than prescription medication, or even face-to-face therapy when it comes to treating insomnia.