Trouble Sleeping? Try Something Other Than Popping Pills

Trouble Sleeping? Counseling and Lifestyle Changes May Work Better Than Popular Pills

Few things can mess up your brain’s functioning more quickly than a few nights of little sleep, or sleep of poor quality. And it’s an issue that affects Americans on a very large scale. According to surveys from the U.S. Department of Health and Human Services, insomnia affects 40 percent of women and 30 percent of men in the U.S. – some 60 million Americans per year.

Risk of insomnia increases with advancing age. According to the Mayo Clinic’s review on the subject, “insomnia can affect you both mentally and physically. The impact can be cumulative. People with chronic insomnia are more likely than others to develop psychiatric problems, such as depression or an anxiety disorder.” They also point out that “lack of sleep slows your problem-solving skills and may make you take unnecessary risks. Long-term sleep deprivation may increase the severity of chronic diseases, such as high blood pressure and diabetes…Insufficient sleep can also lead to serious or even fatal accidents. According to the National Highway Traffic Safety Administration, more than 100,000 crashes each year are due to drivers falling asleep at the wheel.”

All too often, people who need more shut-eye turn to sleep medications. Aggressive direct-to-consumer advertising over the past seven years has boosted the market for these medicines; who hasn’t seen that little animated Lunesta butterfly? Drugs like Ambien and Lunesta – the two top-selling sleep aids – amounted to a $2.1 billion sector of the market between November 2003 and October 2004, a 20 percent increase over the previous year, according to IMS Health Information. Such drugs are indeed effective, but Lunesta is the only one approved for more than short-term use (clinical studies found it safe for up to six months’ use). Lunesta was prescribed about three million times in 2005. But if you can sleep without taking a drug that has potential for interactions, side effects, and addiction, well, why wouldn’t you?

According to a study published recently in the Journal of the American Medical Association, a form of therapy called cognitive-behavioral therapy (CBT) is more effective for long-term treatment of insomnia than a sleep medicine called zopiclone (Imovane) that is chemically very similar to eszopiclone (that’s the generic name for Lunesta). Subjects included 46 patients with insomnia, averaging 60.8 years in age. The researchers gave Imovane to 16 of them and placebo to 12 of them, with the course of treatment lasting six months.

The remaining subjects got a course of CBT that included education about “sleep hygiene” – the use of exercise, diet, and proper sleep environment in creating good sleep. They were placed on a strict sleep/wake schedule designed to create mild sleep deprivation, so that once the patient was in bed, they had an easier time conking out.  They were told to reserve the bedroom for only sleep and sex, and learned progressive relaxation exercises to perform as they drifted off to dreamland. A trained therapist worked with them to identify and modify attitudes, beliefs, and emotions that might be interfering with sleep.

The results: although all three groups got the same quantity of sleep each night, those who got CBT had the greatest improvement in a measurement called sleep efficiency: they spent more of the time in bed actually asleep. Sleep efficiency improved from 81.4 percent to 90.1 percent. CBT subjects also increased the amount of sleep time spent in highly rejuvenating slow-wave sleep. Medication actually reduced sleep efficiency slightly and is known to reduce slow-wave sleep time.

CBT is becoming increasingly popular in therapeutic circles, and is being embraced by psychotherapists all over the nation. You can find a CBT practitioner at, a page at the site of the National Association for Cognitive-Behavioral Therapists (NACBT).


Reference: No authors listed, “New Research: Cognitive Behavioral Therapy to Treat Insomnia is Superior to Sleeping Pills Such as Eszopiclone (LUNESTA),” Worst Pills, Best Pills News, January 2007, Vol 13(1):6-7

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