Emphasizing the complementary in CAM.

580 E ach day of sleep medicine practice brings patients who use a variety of Complementary and Alternative Medicine (CAM) therapies. In this issue Sood and colleagues report on a survey regarding the use of CAM that was administered to sequential patients undergoing polysomnography at their center. 1 The survey indicated that the majority of respondents have used CAM therapies consisting of what Sood terms " biological " therapies (i.e., mostly herbal products, excluding vitamins) and/or " other " CAM therapies such as meditation, stress management, and acupuncture therapies. They note that this is not surprising and is consistent with prior studies in other patient populations. While the majority had used CAM in the past, only 13% had used it specifically for sleep. What does this say about our practice and how should we relate professionally to the use of CAM for sleep problems? The Clinical Practices Review Committee of the American Academy of Sleep Medicine has published a review of the subject of oral nonprescription sleeping aids. 2 It noted that there is not enough evidence to support the use of most of the CAM biological products noted in this study. Medicine, however, has always been a negotiation process. One person's " evidence " is another person's speculation. The process of deciding what works for an individual is more an art than we scientists would like to think. This is especially true when there is a significant body/mind aspect to the subject such as insomnia. Our patients make choices on the basis of their own experience, knowledge and risk/benefit equation. We contribute knowledge and advice. We are the navigators rather than the captains of our patients' ships of health. If patients believe they can fix their sleeping problems by purchasing a simple treatment that doesn't require professional intervention , they are likely to try it. Of interest in the study, 13% of the OSAHS patients had used CAM biologicals for sleep in the past, but only 4% still did so. This implies a rational process of trying out a perceived benign therapy to treat common symptoms of fatigue and sleep fragmentation. This 4% number is about the same cited for CAM use in insomnia in another similar study. 3 In fact, most of these agents don't work very well for initiating and maintaining sleep, especially in patients with OSAHS, and after trying them patients move on to other options. …