Wednesday, November 3, 2010

Boring yourself to sleep may be the best tactic

Yesterday I wrote about discovering by happy luck an editorial by Jon Hanifin on the topic of sleep and itch. Hanifin's an eminent dermatologist at Oregon Health Sciences University in Portland and the author of, among gazillions of papers I'm sure, "A Population-Based Survey of Eczema Prevalence in the United States." This is one of very few major surveys to explore how many people have eczema in this country.

The problem: the study appears in Dermatitis, a journal that my institution doesn't subscribe to. I wrote to Hanifin to ask whether he could send me a copy of the paper, and he very graciously agreed; so now I have that valuable source of data to explore.

Eczema is no rare disease. It affects a lot of people in the U.S., and by extension, worldwide. I'm interested in the U.S. because I live here and because I have some understanding of how science funding works. We might be able to increase funding for eczema research--and, in particular, "translational medicine" leading to a cure--by applying pressure on Congress. Although there's not much evidence that Congress makes decisions based on facts, it won't hurt us to quote some facts when we write our representatives.

Hanifin's editorial led an issue of the journal Sleep Medicine Reviews, and introduced two papers in the issue devoted to the topic of sleep and itch. I read the first of the two papers. According to the authors, eczema is one of several skin diseases for which itch and sleep disturbance is a problem. But there's not much research out there on how to manage sleep problems for patients with eczema. I didn't get too much out of the paper, to be honest. Here's what I learned:

  • The itch of eczema causes sleep disturbance that has effects similar to insomnia; but the eczema is the cause, and if you can manage your eczema, the itch will recede, and your sleep will improve, which will improve your skin in a positive feedback cycle.
  • Doctors prescribe antihistamines for eczema patients almost solely based on the drowsiness they induce. But the authors say there is no study that uses sleep as an objective measure and shows that antihistamines improve sleep.
  • The only sedative that patients reported to improve sleep was nitrazepam (not an antihistamine). However, nitrazepam also induces amnesia, so it's possible the patients just forgot they had a terrible night's sleep.

Not particularly encouraging, hey? In theory, the authors say, doctors should prescribe "hypnotic" drugs like Ambien for short periods only, so that patients can get a few good nights' sleep and break the itch/wake cycle. I've tried Ambien myself, during a period of insomnia a few years back. It didn't knock me out, it just turned me into a zombie the next day. I'd recommend reading something boring-- for me, John McPhee's recent New Yorker article about golf would do the trick.

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