Insomnia: Therapy better than pills

'If you don't sleep, your body is stressed, you crave food, your immune system is compromised.'

'If you don't sleep, your body is stressed, you crave food, your immune system is compromised.'

Published Jun 26, 2015

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London - A trip to a therapist could be better than sleeping tablets for millions of insomniacs, a report claimed recently.

Frequently taking sleeping pills has been linked to diseases including Alzheimer’s. Now scientists say hope is at hand thanks to a form of psychological therapy that can treat chronic insomnia more effectively – knocking an average 20 minutes off the time it takes to nod off.

This method, known as cognitive behavioural therapy (CBT), works because insomnia is often caused by worry and anxiety. And ironically, one of the key causes of anxiety is about not getting to sleep, creating a vicious circle.

The problem across society is immense, with chronic insomnia affecting up to 15 percent of the population. A third of us suffer from poor sleep.

 

The authors of the report examined 20 separate studies into the use of drug-free methods to improve sleep. The Australian research, conducted by the Melbourne Sleep Disorders centre, found CBT reduced the amount of time patients took to fall asleep by an average of 20 minutes. The studies also found the therapy “improved sleep efficiency by about 10 percent”.

Sleep efficiency is measured by calculating how much time you spend asleep after you go to bed and turn the lights off.

The studies did not include sufferers with psychiatric conditions or serious physical ailments.

CBT is a “talking cure” which aims to tackle insomnia by changing the patient’s behaviour and “dysfunctional” ideas about sleep.

It also uses “stimulus control” to encourage insomniacs to associate their bed only with sleeping. The technique bans working or reading in bed and advises that patients should get up if they’re awake for extended periods of time.

Insomniacs are also taught relaxation techniques, told how to reduce muscular tension, and advised to limit their use of caffeinated drinks.

CBT is already available on the NHS as an alternative to sleeping pills. It may be recommended if the insomniac has struggled to sleep for four weeks or more and consists of four to five treatment sessions.

The NHS Choices website advises sufferers to restrict use of the bedroom to “sleeping and sex”, and to avoid bright lights before bedtime, heavy meals and napping during the day.

CBT is considered better than sleeping pills because the treatment after a handful of sessions was still effective six months later – whereas stopping pills can lead to “rebound insomnia”. In addition, patients can develop a tolerance for pills, requiring stronger doses that put their health at greater risk.

An editorial in the journal Annals of Internal Medicine said CBT dealt with the root of the problem rather than just the symptoms.

While some patients may prefer pills as CBT involves “more time and effort”, the editorial said: “The reality is that drug therapy alone does not address the underlying psychological and behavioural factors that perpetuate insomnia.”

It added: “Over the long run, improving sleep and reducing the use of hypnotic medications is likely to improve patient well-being and decrease health care costs.”

The NHS advises GPs to consider non-drug treatments before prescribing pills for insomnia. While they are highly effective at inducing sleep, the pills are only meant to be taken for four weeks. By allowing the patient to have a period of sleeping normally, the hope is that the cycle of sleeplessness will be broken.

But as most insomnia cases are chronic and last much longer than four weeks, the patient requires higher doses, and can become psychologically dependent on them.

After four weeks on benzodiazepene, a common sleeping pill, side effects can include feeling “isolated, unreal and unable to respond to pleasure or pain”.

 

Daily Mail

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