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Insomnia: Talk Beats Sleeping Pills

Cognitive Behavioral Therapy Better Than Pills for Chronic Insomnia
By
WebMD Health News
Reviewed by Louise Chang, MD

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."

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You say you are able to function well with fewer than seven hours of sleep. Some people say they can function on four to six hours of sleep each night, but research shows that adults who get fewer than seven hours of sleep — whether for just one night or over the course of days, weeks, or months — have more difficulty concentrating and more mood problems than people who sleep seven to nine hours.

Since you usually get too little sleep, please talk to your doctor about your sleep patterns. Poor quality sleep can affect many areas of your life and health, and your doctor may be able to help you if you have insomnia or other conditions affecting your sleep.

Sleep deprivation can have both short- and long-term consequences. Learn more about the health consequences of sleep loss. If you're concerned about having trouble falling asleep or staying asleep, assess your risk for a sleep disorder.

It's not surprising you feel that you're not functioning at your best today. Some people say they can function on four to six hours of sleep each night, but research shows that adults who get fewer than seven hours of sleep — whether for just one night or over the course of days, weeks, or months — have more difficulty concentrating and more mood problems than people who sleep seven to nine hours.

Since you usually get too little sleep, please talk to your doctor about your sleep patterns. Poor quality sleep can affect many areas of your life and health, and your doctor may be able to help you if you have difficulty sleeping, have insomnia, or have other sleep disorders.

Learn more about the health consequences of sleep loss. If you're concerned about having trouble falling asleep or staying asleep, assess your risk for a sleep disorder.

It's not surprising you feel that you're not functioning at your best today. Some people say they can function on four to six hours of sleep each night, but research shows that adults who get fewer than seven hours of sleep — whether for just one night or over the course of days, weeks, or months — have more difficulty concentrating and more mood problems than people who sleep seven to nine hours.

It's good that you usually do get more sleep, since sleep deprivation can have both short- and long-term consequences. Learn more about the health consequences of sleep loss. And if you're concerned about having trouble falling asleep or staying asleep, assess your risk for a sleep disorder.

You say you are able to function well with fewer than seven hours of sleep. Some people say they can function on four to six hours of sleep each night, but research shows that adults who get fewer than seven hours of sleep — whether for just one night or over the course of days, weeks, or months — have more difficulty concentrating and more mood problems than people who sleep seven to nine hours.

It's good that you usually do get more sleep because sleep deprivation can have both short- and long-term consequences. Learn more about the health consequences of sleep loss. And if you're concerned about having trouble falling asleep or staying asleep, assess your risk for a sleep disorder.

It's not surprising you feel that you're not functioning at your best today. Some people say they can function on four to six hours of sleep each night, but research shows that adults who get fewer than seven hours of sleep — whether for just one night or over the course of days, weeks, or months — have more difficulty concentrating and more mood problems than people who sleep seven to nine hours.

Since you usually get less sleep, please talk to your doctor about your sleep patterns. Poor quality sleep can affect many areas of your life and health, and your doctor may be able to help you if you have difficulty sleeping or have insomnia or other sleep disorders.

Learn more about the health consequences of sleep loss. If you're concerned about having trouble falling asleep or staying asleep, assess your risk for a sleep disorder.

It's wonderful that you got a good night's sleep last night. Many people struggle to do so. Having a good sleep routine often is the key to getting the quality sleep night after night that your body needs for optimal health. Whether your sleep routine involves taking a warm bath, reading a book, or meditating, it's important to keep your bedtime and routine consistent every night and wake up around the same time every morning.

Click here to read more about the importance of sleep. If you're concerned about having trouble falling asleep, staying asleep, or sleeping too much, assess your risk for a sleep disorder.

It's unfortunate you're not functioning at your best today. You say you had a good quantity of sleep last night, but maybe the quality of your sleep is not as good as it could be? Having a good sleep routine — including a consistent bedtime and wake time — often is the key to getting the quality sleep night after night that your body needs for optimal health. Since you usually sleep this amount, if you often aren't feeling your best, you should consider talking to your doctor. Could you have an underlying condition? Are you feeling anxious or depressed? Have you taken medication that disrupted your sleep? Do you or could you have sleep apnea? Or do you naturally require a little bit more sleep?

Although sleep is crucial for optimal health, some research suggests that sleeping too much can also have negative consequences. Learn more about sleep. If you're concerned about having trouble falling asleep, staying asleep, or sleeping too much, assess your risk for a sleep disorder.

It's unfortunate you're not functioning at your best today. You say you had a good quantity of sleep last night, but maybe the quality of your sleep is not as good as it could be? Having a good sleep routine — including a consistent bedtime and wake time — often is the key to getting the quality sleep night after night that your body needs for optimal health. Since you usually sleep longer, if you often aren't feeling your best, you should consider talking to your doctor. Could you have an underlying condition? Are you feeling anxious or depressed? Have you taken medication that disrupted your sleep? Do you or could you have sleep apnea? Or do you naturally require a little bit more sleep?

Although sleep is crucial for optimal health, some research suggests that sleeping too much can also have negative consequences. Learn more about sleep. If you're concerned about having trouble falling asleep, staying asleep, or sleeping too much, assess your risk for a sleep disorder.

It's wonderful that you got a good night's sleep last night. Many people struggle to do so. Having a good sleep routine often is the key to getting the quality sleep night after night that your body needs for optimal health. Whether your sleep routine involves taking a warm bath, reading a book, or meditating, it's also important to keep bedtime consistent and wake up around the same time every morning.

Although sleep is crucial for optimal health, some research suggests that sleeping too much can have negative consequences. Learn more about sleep. If you're concerned about having trouble falling asleep, staying asleep, or sleeping too much, assess your risk for a sleep disorder.

It's unfortunate you're not functioning at your best today. You say you had a good quantity of sleep last night, but maybe the quality of your sleep is not as good as it could be? Having a good sleep routine — including a consistent bedtime and waking up at the same time — often is the key to getting the quality sleep night after night that your body needs for optimal health.

Since you usually get less sleep, please talk to your doctor about your sleep patterns. Poor quality sleep can affect many areas of your life and health, and your doctor may be able to help you if you have insomnia, another sleep disorder, or conditions affecting your sleep.

Learn more about the health consequences of sleep loss. If you're concerned about having trouble falling asleep or staying asleep, assess your risk for a sleep disorder.

It's wonderful that you got a good night's sleep last night. Many people struggle to do so. Having a good sleep routine often is the key to getting the quality sleep night after night that your body needs for optimal health.

Since you usually get less sleep, talk to your doctor about your sleep patterns. Poor quality sleep can affect many areas of your life and health, and your doctor may be able to help you if you have insomnia or another sleep disorder or conditions affecting your sleep.

Learn more about the health consequences of sleep loss. If you're concerned about having trouble falling asleep or staying asleep, assess your risk for a sleep disorder.

SOURCES:

Centers for Disease Control and Prevention (CDC). Effect of short sleep duration on daily activities--United States, 2005-2008. MMWR Morb Mortal Wkly Rep 2011; 60:239.

Carskadon, MA, Dement, WC. Normal Human Sleep: An Overview. In: Principles and Practices of Sleep Medicine, Fifth, Kryger, MH, Roth, et al. (Eds), Elsevier Saunders, St. Louis, MO 2011. p.16.

Harvard University: "Sleep, Performance, and Public Safety."

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