Sleep Disorders

28 June 2006

Therapy best for insomnia

People with chronic insomnia can get more and deeper sleep if they receive cognitive behavioural therapy to treat their sleep disorder.

While popping a sleeping pill may be the solution for an occasional sleepless night, people with chronic insomnia can get more and deeper sleep if they receive cognitive behavioural therapy to treat their sleep disorder.

That's the conclusion of a Norwegian study that found that cognitive behavioural therapy (CBT) was better at treating long-term insomnia than the sleep medication zopiclone, which is very similar to the widely advertised drug Lunesta, the researchers said.

"The findings showed that CBT was superior to sleep medications for older individuals suffering from chronic insomnia. In fact, zopiclone did not perform better than placebo pills," said the study's lead author, Dr Borge Sivertsen, an associate researcher at the Norwegian Competence Centre for Sleep Disorders.

Additionally, "CBT increased the patients' slow-wave sleep (deep sleep) compared to a significant decrease caused by zopiclone. This finding is especially important, as a lack of slow wave sleep may be responsible for impaired daytime functioning and next-day sleepiness," he said.

Results of the study appear in the June 28 issue of the Journal of the American Medical Association.

Almost 60% of people affected
Sleeplessness is a substantial problem. According to the US National Sleep Foundation (NSF), almost six of 10 people report having insomnia at least a few nights weekly. Insomnia becomes chronic if you have trouble either falling asleep or staying asleep for longer than one month.

As many as 25 percent of people in the United States use medications to help them sleep at least once every year, according to the NSF. The use of prescription sleep medications, such as Ambien, Lunesta and Sonata, has been increasing, and while these drugs are effective for short-term sleeping problems, users can build up a tolerance to them and they lose their effectiveness, according to Susan Zafarlotfi, clinical director for the Institute for Sleep-Wake Disorders at Hackensack University Medical Centre in New Jersey.

For the new study, 46 people over 55 years of age were recruited for the study; to be included, the volunteers had to have had insomnia for three months or longer.

Eighteen participants received cognitive behavioural therapy, which included six weekly individual treatment sessions in which they were given information on relaxation techniques, how to control their sleeping environment to reduce stimuli, and how to restrict sleeping hours so it's easier to fall asleep at bedtime. Sixteen people were given 7.5 milligrams of zopiclone nightly for six weeks. This medication is very similar to Lunesta, according to Zafarlotfi. The remaining 12 volunteers received a placebo.

Study results were measured at six weeks and then again at six months for the medication and cognitive behavioural therapy group.

Best results with therapy
Those receiving CBT improved their "sleep efficiency" from 81.4 percent to 90.1 percent by the end of the 6-month study, while the zopiclone group decreased from 82.3 percent to 81.9 percent. While total sleep time was similar for all three groups at six months, people who received CBT spent more time in slow-wave sleep and woke up less during the night than people in the other two groups, according to the study.

"We are concerned with the growing consumption of sleep medications seen in most Western countries. The most important message from this study is that this non-pharmacological alternative based on CBT is the better choice for treating chronic insomnia in older adults," Sivertsen said.

"In addition to having superior treatment efficacy, CBT produces no adverse effects, such as dizziness, drowsiness, headaches or next-day sleepiness, which are commonly experienced after use of sleep medications," he added.

Meds only a temporary solution
Both Sivertsen and Zafarlotfi said there's still a place for medications in treating short-term insomnia, but their use should be limited to a few weeks. Zafarlotfi likens the use of sleep medications to needing crutches after you break your leg. For a short time, you need the crutches, but then if you want your leg to truly get better, you have to put the crutches away and start exercising your leg.

"Once you can stand back on your feet, you need to give up the crutches," she explained. And, she added, cognitive behavioural therapy helps people to give up the crutch of sleep medications. "CBT is a specific tool you give patients. It works much better than any type of medication because there is never a golden drug that is always going to work forever."

Sivertsen said if you're having trouble sleeping, don't stay in bed. He said this can inhibit your body's sleep drive. Get up and do something non-stimulating until you feel as if you can sleep. He said it's very important to get up at the same time everyday, including on the weekends and to avoid taking daytime naps.

Other things that can help you sleep are avoiding alcohol, caffeine and nicotine in the hours before bedtime. – (HealthDayNews)

Read more:
Sleepless in SA – peer forum

June 2006


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Dr Alison Bentley is a general practitioner who has consulted in sleep medicine and sleep disorders, in both adults and children of all ages, for almost 30 years. She also researches and publishes on a number of sleep-related topics both in formal research journals and lay publications including as editor of Sleep Matters, an educational newsletter on sleep disorders for doctors.

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