What’s Behind a Good Night’s Sleep?
Researching placebo effects in insomnia treatment By Kimberly N Uweh, PharmD
Jon Krause
W
hen I was a child, my grandmother told me that healing begins in the mind, but I objected, saying that healing starts when you take medicine. Fast forward 20 years later and I am a pharmacist, learning about mental health, psychiatric medications, and inconsistent patient response. That’s when it finally clicked: my grandmother was right! Many psychiatric patients take their medications as prescribed, but recovery is hampered by their belief that they will not get better, and this may be further complicated by a negative relationship with their doctor. To begin my journey to understand this problem, I earned a highly coveted postdoctoral fellowship for the GeorgetownHoward Universities Center for Clinical and Translational Science (GHUCCTS) TL1 Award Program. I have the privilege of being mentored and trained by pioneering sleep researchers Ihori Kobayashi, PhD, assistant research professor, and Thomas A. Mellman, MD, professor, both in the Department of Psychiatry and Behavioral Sciences at Howard University College of Medicine. Mellman is principal investigator for the study I’m working on, and director of both GHUCCTS and the Sleep and Stress Research Program at Howard University. When I began my fellowship, I didn’t know the clinical implications from unresolved sleep issues that persist for months and develop into insomnia. Insomnia is the most prevalent sleep disorder in the United States, and approximately one in five Americans develops the condition each year. Thirty percent of the U.S. adult population suffers from acute term
insomnia and ten percent of the population experiences chronic insomnia. Many patients resort to hypnotics and experience side effects, and do not obtain relief from their medications. Sleep is essential to basic human functioning but on a deeper level, sleep is an opportunity for every living being to restore and heal itself. The benefits of sleep include stress reduction and improved memory, along with lower occurrence of diabetes, mood disorders, obesity, and heart disease. Many people miss out on the benefits of sleep, and seek medical help for insomnia. Our current sleep treatment practices rely too heavily on the sole use of sleep medications, which come with side effects and potential for dependency. Our patients need and deserve more than prescription drugs to overcome their sleep issues. In pharmacy school we learned that if patients were compliant in taking their medications, they would be fine. When this did not seem to translate for patients with insomnia, I remembered my grandmothers comment on healing beginning in the mind. I researched mind and body medicine, and arrived at the question of how placebos benefit patients during clinical trials. Perhaps this was the missing link. At our next weekly lab meeting, we were reviewing participant cases from our ongoing double blind randomized clinical trial. All reported that they were doing great. Then a light bulb went off in my head! Could some participants be experiencing a placebo effect? After our lab meeting, I pitched my fellowship project idea to my mentors: examine the
characteristics of placebo effects during an insomnia clinical trial. I got the green light. My goal is to gain insight into the extent to which a patient can get better while receiving a placebo and also how it compares to a drug. We have our study participants complete questionnaires and sleep diaries throughout the clinical trial. And we use polysomnography, a multiparametric test and diagnostic tool to record brain waves while our participants sleep overnight in the lab. Understanding placebo effects taking place in my lab’s clinical trial for insomnia serves as an opportunity to maximize utility of placebos in future insomnia treatments based on mind-body medicine. From taking in my grandmother’s seeds of wisdom about healing to then becoming a clinical pharmacist, I have gone full circle as a researcher in this area. The occurrence and benefits of placebo effects are established in disease states such as pain and depression, yet there is currently limited research in sleep disorders. By conducting foundational research, I hope to use my interest in mind-body medicine to become a pioneer in understanding placebo effects in insomnia. n Completing her second year as a GHUCCTS fellow, Kimberly enjoys healing people through art and science. She is also an aspiring fashion designer.
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