NPR logo To Beat Insomnia, Try Therapy For The Underlying Cause Instead Of Pills

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To Beat Insomnia, Try Therapy For The Underlying Cause Instead Of Pills

Ikon Images/Corbis i
Ikon Images/Corbis
Ikon Images/Corbis
Ikon Images/Corbis

Lots of people say they have trouble sleeping. And 1 in 10 Americans has chronic insomnia.

Most often, sleep disorders are treated with medication. Between 6 and 10 percent of adults in the U.S. use sleeping pills.

But a review of the medical evidence has found that therapy might help people with chronic sleep troubles just as much — or even more — than pills.

Evidence that cognitive behavioral therapy — a form of talk therapy that focuses on changing how a person reacts to specific situations — can help people with chronically bad sleep has been growing over the past decade, says Dr. David Cunnington, director of the Melbourne Sleep Disorders Centre in Australia and the senior author of the recent study.

"We wanted to pull together all the smaller studies that have been done on cognitive behavioral therapy for insomnia," Cunnington says, "to really get a bigger pool of data and a better idea of how effective this is."

The results were published Monday in the Annals of Internal Medicine.

A typical treatment plan for insomnia includes four to six sessions with a sleep psychologist. Therapists help train patients to wake up at the same time every day and develop good sleep habits , such as avoiding alcohol or caffeine near bedtime and reserving their bed for sleep (rather than watching TV, for example). They also teach relaxation techniques and challenge people's negative attitudes toward sleep.

After completing therapy, on average, patients fell asleep almost 20 minutes faster and were awake in the middle of the night almost half an hour less, the study found. And the time they spent sleeping soundly increased by nearly 10 percent.

"Based on other studies, we know that these results from therapy are very similar to what you'd see with patients who take medication," Cunnington says.

In many cases, therapy is a better treatment option, since it treats the underlying anxieties that cause insomnia. "A medication just puts a blanket over that anxiety and helps people get rest," Cunnington says. "But cognitive behavioral therapy addresses the core problems, challenging people's thinking around sleep. It can actually break the cycle of chronic insomnia."

Plus, medications can come with side effects — like feeling sedated all day. And most sleeping pills lose their effectiveness over time, Cunnington notes.

So why don't more doctors recommend therapy for sleep problems?

"I think it's an issue of awareness," says Kelly Baron, a clinical psychologist at the Northwestern University Feinberg School of Medicine who specializes in sleep disorders.

"This review definitely gives us some hard and fast numbers on the efficacy of therapy," says Baron, who wasn't involved in the recent study.

But primary care doctors often don't know where to refer patients with chronic sleep issues, Baron says. And there's a shortage of therapists who are trained to treat insomnia, especially outside of big cities.

Proponents of therapy for insomnia are working to develop a better certification program for sleep psychologists, Baron says. "What we really need to focus on at this point is increasing accessibility, so more people with sleep disorders have the option to choose therapy if they want it."

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