Short Insomnia Therapy Beats Sleeping Pills
4 Half-Hour CBT Sessions Work Better, Last Longer Than Ambien
Head-to-Head: CBT vs. Ambien vs. Combination continued...
CBT-treated patients who didn't achieve normal sleep patterns still got to sleep much faster they did before treatment.
"For many of them, instead of taking an hour and a half, they are sleeping in 45 minutes," Jacobs says. "They increase their sleep time and reduce their waking time. That, to them, is a major success."
One might think that giving patients Ambien plus CBT would work better. But the combination wasn't any better than CBT alone. That's a surprise, says Simon.
"If a person comes in with chronic insomnia, it takes a while for CBT to have an impact," Simon says. "So we often give a sleeping pill for the first few weeks. But the Jacobs study shows that the combination does not seem to add much. That is an interesting finding."
CBT: Long-Lasting Effect
The debate over the relative efficacy of sleeping pills versus CBT has smoldered for a long time, notes sleep researcher Milton Kramer, MD, director of psychiatric research at Maimonides Medical Center, New York, and clinical professor of psychiatry at New York University.
"The core issue relates to effectiveness over time," Kramer tells WebMD. "A lot of studies show CBT can be effective, and a year after treatment patients still have made gains. With sleep medications, there's always been a question of effectiveness when treatment ends."
CBT's long-lasting effect gives it an advantage over sleeping pills, says sleep expert Max Hirskowitz, PhD, associate professor of medicine and psychiatry at Baylor College of Medicine, Houston.
"If we treat you with Ambien you will sleep, but when we stop treating, you are likely to go back to not being able to sleep. CBT gives tools with which people can help themselves in the longer run. With CBT, the benefits endure," Hirskowitz tells WebMD.
But there are drawbacks.
"The disadvantage to CBT is that it is not widely available. In many locations, it is difficult to find a practitioner who knows how to do it properly," Hirskowitz says. "And it is time consuming."
That's just what Jacobs is trying to get around. He notes that his team gets results with just four half-hour sessions -- less than the six to eight CBT sessions common for other psychiatric treatments. True, he says, doctors and psychologists need training before they can treat insomnia with CBT. But not everyone with insomnia needs a top-notch CBT therapist.
"Whether a person will benefit from simple guidelines or in-depth CBT depends on the patient," Jacobs says. "Some can go on WebMD and see this article, or reference my book, Say Goodnight to Insomnia, and that is all they need. This is not something you necessarily have to find at a sleep clinic."