Pills Plus Psychotherapy Can Beat Insomnia

TUESDAY May 19, 2009 -- If you've been having trouble falling asleep or staying asleep, a new study suggests that the short-term use of sleep medications plus behavioral changes may be the best combination for getting your zzz's.

The Canadian study, which appears in the May 20 edition of the Journal of the American Medical Association, found that the short-term addition of the sleep medication, zolpidem (Ambien), coupled with cognitive behavioral therapy, helped more people overcome persistent insomnia.

"When we treat persistent insomnia in adults, we can use cognitive behavioral therapy alone or in combination with medications. This study found an added value to adding medications for the short-term," said study author Charles Morin, Canada Research Chair in Sleep Disorders at Laval University in Quebec.

"Insomnia significantly impairs quality of life, and it's a very costly problem for society at large," explained Morin. Effective treatment of insomnia, he said, might lead to higher productivity at work and a better overall quality of life.

According to the researchers, cognitive behavioral therapy for insomnia helps to re-teach patients good sleep habits. Another approach is sleep medications -- such as zolpidem (Ambien), eszopiclone (Lunesta) and zaleplon (Sonata).

These are the only treatments with consistent research supporting their use in treating insomnia, according to the study authors. However, each option is generally used on its own.

Morin and his colleagues wanted to know if a combination of cognitive behavioral therapy and sleep medication would improve sleep for people with chronic insomnia.

Their study included 160 adults with persistent insomnia. All were treated at a Canadian university hospital sleep center between 2002 and 2005.

The study volunteers were randomly assigned to receive cognitive behavioral therapy alone or cognitive behavioral therapy plus 10 milligrams a day of Ambien taken at bedtime for six weeks. Both groups also received an additional six months of cognitive behavioral therapy, or CBT. The Ambien group was also allowed to take the medication on an as-needed basis during the six month follow-up period.

There was little difference in the number of people who responded to treatment, however: 44 percent of the combination group reported relief from their insomnia versus 39 percent of the CBT-alone group.

But, the researchers found that in the long-term, CBT-alone is the most effective strategy. After six months, 68 percent of the CBT-alone group reported insomnia remission versus 42 percent of the combination group.

"In the long run, CBT is really the treatment of choice," said Morin.

"Just doing medication or CBT-alone can be beneficial, but by combining the two, you may get more results," added Shelby Freedman Harris, director of the behavioral sleep medicine program at the Montefiore Sleep-Wake Disorders Center in New York City.

If You're Seeking Shut-Eye

If you've been having trouble getting to sleep or staying asleep, Shelby Freedman Harris, director of the behavioral sleep medicine program at the Montefiore Sleep-Wake Disorders Center in New York City, has some suggestions that may help you get a restful night:

  • Limit your caffeine use, including coffee, tea, soda, iced tea and chocolate.
  • Exercise, but do so at least five or six hours before bedtime.
  • Limit alcohol and cigarette use. Stop both at least three hours before bedtime because they can disrupt your sleep.
  • Don't lay in bed awake. "Don't look at your clock all night. When you first notice that you're just laying there, and you start to feel frustrated that you can't sleep, get up and go do something relaxing in dim light," she advised.
  • Only use your bed for sleep and sex. Don't watch TV in bed.
  • Keep the same bedtime and awakening time seven days a week.

Harris said that most adults need between seven and nine hours of sleep a night. How do you know if you're getting enough sleep? "If you're sleeping well throughout the night and you wake up feeling refreshed, you're at the right number of hours," she said.

Posted: May 2009


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