Short Insomnia Therapy Beats Sleeping Pills

Sept. 27, 2004 -- Need help getting to sleep? Four half-hour therapy sessions work better than sleeping pills, a new study shows.

It's called cognitive behavioral therapy or CBT. CBT helps people recognize, challenge, and change unhelpful thoughts and behaviors. But can this really work better than modern sleeping pills?

Yes, finds Gregg D. Jacobs, PhD, a psychologist at the sleep disorders clinic of Beth Israel Deaconess Medical Center and assistant professor of psychiatry at Harvard Medical School in Boston.

"If someone has insomnia, [he or she doesn't] have to live with it. An effective treatment exists," Jacobs tells WebMD. "It is not a drug, but CBT. It works better than sleeping pills in the short term and in the long term -- and has no side effects."

Jacobs and colleagues report their findings in the Sept. 27 issue of Archives of Internal Medicine.

CBT isn't a new treatment. It's already the mainstay of therapy for most sleep specialists, says Richard Simon Jr., MD, medical director of the Katheryn Severyns Dement sleep disorder center in Walla Walla, Wash.

"My experience says this is right on the money," Simon tells WebMD. "As a sleep specialist I do it and I get very, very good results. No sleep specialist would disagree that CBT is the mainstay of therapy. This study clearly indicates robust effects." Having trouble sleeping? Take this quick quiz.

Head-to-Head: CBT vs. Ambien vs. Combination

What makes Jacobs so excited are the results of a study with 63 insomnia sufferers recruited via newspaper ads. The patients were randomly assigned to one of four treatments: CBT, Ambien, CBT plus Ambien, or a placebo pill.

CBT consisted of four, 30-minute sessions (once weekly for three weeks, then a final session two weeks later) plus a 15-minute follow-up phone call.

Why Ambien and not some other sleeping pill?

"We picked Ambien because it is one of two approved newer-generation sleeping pills -- the other is Sonata -- that work selectively in brain and have reduced side effects," Jacobs says. " Ambien, from our perspective, is the best choice on the market if you have sleep onset problems, because it works as well as others without as many side effects."

It may be the best sleeping pill for people who have trouble getting to sleep. But it doesn't work nearly as well as CBT, Jacobs and colleagues found. Insomnia sufferers got to sleep faster and more efficiently after CBT than after taking Ambien. In fact, nearly 60% of the CBT-treated patients got to sleep just as fast as people without insomnia do -- in 30 minutes or less.

"These results are extremely impressive," Jacobs says. "When you take people who have long-standing insomnia -- who every night need more than an hour to fall asleep -- and say 60% get to normal sleep, that is outstanding data."