Insomnia: Talk Beats Sleeping Pills

June 27, 2006 -- A few talk therapy sessions help long-lasting insomniainsomnia better than sleeping pills, Norwegian researchers find.

The simple treatment is a form of cognitive behavioral therapy (CBT). It isn't brain surgery -- or even in-depth psychotherapy. It's all about learning how to change behaviors and thought patterns that interfere with sleep.

Can such a relatively simple treatment work as well as state-of-the-art sleeping pills? Yes, find Børge Sivertsen, PsyD, and colleagues at the University of Bergen in Norway. They randomly treated 46 long-term insomniacs with CBT, Imovane, or inactive placebo pills. Imovane, a sleep drug closely related to Lunesta, is commonly used in Europe but is not available in the U.S.

After six weeks of treatment -- and again six months after treatment – the researchers studied how well the patients were sleeping.

Before treatment, these insomnia sufferers were awake about 20% of the time they were in bed. After six weeks, those who got CBT were awake only about 10% of the night. Six months later, this positive effect was a bit stronger.

Meanwhile, at both time points, those who got the sleeping pill spent just as much sleepless time in bed as they had when the study began.

"We were surprised," Sivertsen tells WebMD. "We expected CBT to be efficient, but we did not expect such strong differences between groups."

But this is no surprise to long-time CBT enthusiast Richard Simon Jr., MD, medical director of the Kathryn Severyns Dement Sleep Disorders Center, in Walla Walla, Wash.

"The main finding of this study is extraordinarily consistent with everything in the medical literature," Simon tells WebMD. "The bottom line is that whenever one compares CBT to sleep medications, CBT is always at least as good if not better -- and, typically, the effect of CBT is longer lasting."

The Sivertsen study appears in the June 28 issue of the Journal of the American Medical Association.

Insomnia, Deep Sleep, and CBT

What surprised both Sivertsen and Simon was the effect of the different treatments on the patients' slow-wave sleep -- what most of us call deep sleep.

CBT raised the patients' average slow-wave sleep 27% by the end of treatment, and had increased it 34% six months later.

On the other hand, patients who took the sleeping pill had a big drop in the amount of slow-wave sleep they got. They had 20% less slow-wave sleep at the end of treatment. Six months later, they had 23% less slow-wave sleep.

"That is scary, when you see that lack of slow-wave sleep is responsible for most daytime sleepiness," Sivertsen says. "And there is an ongoing debate in the American media about traffic-related incidents with sleeping pills."

Simon isn't totally convinced by the finding.

"For most of the newer sleep medications, investigators have found no decrease in [slow-wave] sleep," he says. "But with the older drugs, like Halcion, that is a common finding."

"We were quite surprised to find that [Imovane] decreased slow-wave sleep," Sivertsen says. "The manufacturer says [Imovane] increases slow-wave sleep. We found the opposite. True, we had a relatively small number of patients. But all the patients in the placebo arm were randomized to get one of the two treatments. If we put those additional patients into the final analysis, we get even larger effects. The findings were still there and still significant."