Psychotherapy, Not Sleeping Pills, Best for Insomnia

Millions of Americans suffering from insomnia are quick to head to their medicine cabinets and pop an Ambien to get a good night’s sleep. But there’s a better way to meet Mr. Sandman that doesn’t come with the side effects of taking a sleep drug: psychotherapy.

A mix of talk therapy and education about proper sleep techniques, known as cognitive behavioral therapy for insomnia (CBT-I), is better than reaching for a pill for chronic insomnia sufferers, according to new guidelines out from the American College of Physicians (ACP). Chronic insomnia is considered having sleep difficulties that happen at least 3 times a week for a minimum of 3 months that can impair activities.

Although many with insomnia are quick to ask their doctor for a sleeping med prescription, those drugs can lead to a host of side effects, including excessive sleepiness, dizziness, lightheadedness and a “drugged” feeling. They are only supposed to be taken for a relatively short period, usually 4 or 5 weeks at the most.

“Although we have insufficient evidence to directly compare CBT-I and drug treatment, CBT-I is likely to have fewer harms,” ACP President Wayne J. Riley, MD, said in a statement. “Sleep medications can be associated with serious adverse effects.”

CBT-I is designed to change the behavior of insomniacs, thoughts about sleep and what they do while they are awake in order to promote better sleep. They are also required to keep sleep logs. The techniques can be done through individual or group therapy sessions, telephone, on the Internet or self-help books.

Some of the specific techniques involved include stimulus control (establishing consistency in sleep patterns by associating sleep with the bed and bedroom, aka, only going to sleep when tired), sleep restriction (limiting time in bed to sleep only) and relaxation training (controlling bedtime thought patterns that may impair sleep).

Although CBT-I can take several weeks to master as opposed to getting the instant relief of swallowing a pill, experts say that the lessons learned can be applied long after the therapy sessions are over.

The ACP came out with a second, albeit weaker, recommendation to follow when CBT-I doesn’t seem to work: that doctors weigh the benefits, risks and costs of short-term use of sleep meds in deciding whether to add it to an insomniac’s treatment plan.


Jonathan Block

Jonathan Block

Jonathan Block is an associate editor at BioCentury, which provides news and information about the biotechnology and pharmaceutical industries. Prior to joining BioCentury in 2019, Jonathan worked for MedShadow as content editor. He has been an editor and writer for multiple pharmaceutical, health and medical publications, including The Pink Sheet, Modern Healthcare, Health Plan Week and Psychiatry Advisor. He holds a BA from Tufts University and is earning an MPH with a focus on health policy from the CUNY Graduate School of Public Health & Health Policy.


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