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."
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.