Sleepless in Latin America

Human bodies may be different but they all require various amounts of food, fluid and rest in order to function.  In particular, insomnia is the sleeping disorder by characterized by the inability to fall asleep, waking up frequently during the sleep, waking up too early and/or sleep that is not refreshing.   Insomnia may lead to attention lapses, impaired judgment, memory loss (traveler's amnesia), depression, hypertension, and metabolic and hormonal disruptions.  Sometimes, insomnia is imposed by personal or work obligations.  Other times, insomnia occurs in spite of every attempt to fall asleep.  

When insomnia strikes, it may be necessary to seek remedies.  Traditional herbal treatments for insomnia include chamomile, rosemary, skullcap, valerian root, hops, kava and lemon balm.  Or one may try various kinds of over-the-counter sleeping medications.  Antihistamines are the active ingredients in most of these medications that include diphenhydramine alone (Nytol, Sleep-Eez, Sominex) or in combination with pain relievers (Anacin P.M., Excedrin PM, Tylenol PM), doxylamine (Unison), and pyrilamine (Quiet World).  These drugs can leave the users drowsy the next day, and they may not be universally effective for all.  

More serious cases of insomnia may require prescription drugs.  Once upon a time, barbiturates (such as Seconal and Nembutal) were standard prescriptions, but they are dangerous due to the problems of overdose, addiction and abuse.  Today, the more common sleep prescription drugs are benzodiazepines such as lorazepam (Ativan), alprazolam (Xanax), triazolam (Halcion), flurazepam (Dalmane), temazepam (Restoril), oxazepam (Serax), prazepam (Centrax), quazepam (Doral), estazolam (ProSom), and flunitrazepam (Rohypnol).  Although overdoses are rare from benzodiazepines, depression and withdrawal symptoms such as recrudescence can still occur.  Non-benzodiazepines such as Zolpidem (Ambien), zaleplon (Sonata), and zopiclone (Imovane) are short-acting drugs that may not pose as high a risk for drug tolerance or dependence as the longer-acting benzodiazepines.  Given the potential dangers posed by these hypnotic drugs, prescription is probably a doctor's last resort rather than the first option.

We will now cite some survey data from the TGI Latina study.  This is a survey of 48,885 persons 12 years or older interviewed during 2001 in eight Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico, Panama, Peru and Venezuela).  According to the TGI Latina study, 2.2% of the respondents said that they used an anti-insomnia prescription drug during the past 12 months.

In the next chart, we show the incidences by gender and age groups.  The incidences are significantly higher among older women.

Insomnia has many causes.  Contributory factors include behavioral patterns such as daytime napping, excessive indulgence in stimulants such as caffeine and nicotine, substance abuse (such as alcohol) and lifestyles.  More intangible are the psychological factors such as anxiety and stress at work or home.  Indeed, the phrase 'Don't lose any sleep over it' is a standard way of telling someone not to worry.

In the next chart, we show the incidences of insomnia prescription usage by socio-economic status, occupation and education.  This would superificially support the notion that the rich and educated are the ones who could not sleep.  We must caution that these results do not imply that the rich sleep badly!  These results refer only to the usage of prescription drugs which may be more easily available to those with financial means and medical access.

In the next chart, though, we show the results for what is presumably a more direct measure of stress and anxieity.  Here, the respondents have been classified according to their responses to the retrospective and prospective questions about consumer confidence.  For both questions, those who are worse now than before or who expect to be worse soon than now are the ones who have used insomnia prescription drugs.

Other than taking over-the-counter and prescription drugs, people are also advised to watch their schedules, maintain a sleep-friendly environment (with respect to noise, temperature, comfort and companionship), watch their diets, minimize alcohol intake and do exercises.  But if the underlying causes are the economic problems due to macro-economic forces and events, then none of these procedures and precautions will help to eliminate the root problems. 

(posted by Roland Soong, 4/21/2002)