Cognitive Behavioral Therapy Works Better Than Newer Sleep Medication for Insomnia
Most of us have experienced an occasional sleepless night. But up to 25% of adults over the age of 55 suffer from chronic insomnia, enduring months or even years of difficulty falling or staying asleep. The inadequate and often poor-quality sleep they do get makes it difficult to function during the day. As many as one in five individuals with insomnia turn to over-the-counter medications or alcohol in hopes of getting a good night’s sleep, and many physicians readily prescribe medications to treat insomnia. But could cognitive behavioral therapy—which attempts to adjust expectations about sleep while providing strategies to improve it—be a better alternative to sleep medication?
In an article published in the June 28, 2006 issue of the Journal of the American Medical Association , researchers report that insomnia patients treated with cognitive behavioral therapy had significantly greater improvements in their sleep, compared to patients taking placebo or zopiclone (Imovane) a newer, non-benzodiazepine sleep medication.
About the Study
The researchers recruited 46 men and women (average age 60.8 years) with chronic insomnia, which affected their daytime function. Eighteen patients participated in six sessions of cognitive behavioral therapy (CBT); sixteen patients took 7.5 milligrams of the sleep medication zopiclone every night for six weeks; and the remaining twelve participants took a placebo every night for six weeks.
Using a sleep study known as polysomnography (PSG), as well as sleep diaries maintained by the patients, the researchers calculated the participants’ total wake time, total sleep time, sleep efficiency (ratio of time spent asleep to time spent in bed), and slow-wave sleep (time spent in sleep stages 3 and 4, the quality of which affects daytime function). These measurements were taken at the start of the study, and then at six weeks and six months.
At six weeks, the total wake time and the amount of time spent in slow-wave sleep had improved significantly for the CBT group, compared to the zopiclone and placebo groups. However, there was no difference between the groups in total sleep time. Six months after the start of the study, the CBT group had significantly better total wake time, sleep efficiency, and slow-wave sleep, compared to the zopiclone group. Again, there was no difference in total sleep time.
This study was limited by it small size of only 46 study subjects. In addition, the findings were specific to zopiclone, and cannot be generalized to other sleep medications.
How Does This Affect You?
This study found that cognitive behavioral therapy significantly improved many measures of sleep in adults with insomnia, compared to placebo and zopiclone. Unfortunately, the researchers did not measure daytime sleepiness to assess whether the improvements in sleep measurements corresponded to functional benefits for the study participants.
Sleeping pills may provide a quick fix when you’re tired and anxious about falling asleep, but sleep medications come with risks, including dependence.
Cognitive behavioral therapy focuses on changing or managing aspects of sleep that are under your control. For example, you may be advised to adjust the light or noise level in your bedroom, to use your bedroom only for sleeping, or to sleep and rise at specific times no matter how little sleep you’ve gotten. You will likely be taught relaxation techniques, and encouraged to form realistic expectations about sleep.
Talk with your doctor if you’re interested in learning more about cognitive behavioral therapy. With a little investment in time and effort, your insomnia may become one less thing to lose sleep over.
American Insomnia Association
National Institute on Aging
National Institutes of Health
Siversten B et al. Cognitive behavior therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. J Am Med Assoc . 2006; 295:2851-2858.
Last reviewed June 2006 by ]]>Richard Glickman-Simon, MD]]>
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