According to Canadian scientists, Cognitive Behavioral Therapy (CBT) in combination with the medication zolpidem, may be the most effective way to battle persistent, or chronic insomnia. The experts say that teaching insomnia sufferers how to fall asleep through talk therapy will provide them with much better positive results than sleep drugs that carry dependency risks.
Doctor Charles Morin, Canada Research Chair in Sleep Disorders at Laval University in Quebec, says that persistent insomnia reduces quality of life, it has a negative impact on daytime functioning but what is even worse, chronic insomnia is a risk factor for developing major depression. "Insomnia significantly impairs quality of life, and it is a very costly problem for society at large," explained Dr. Morin. Effective treatment of the condition, he added, might lead to better productivity at workplace and a higher overall life quality.
For a study purposes, the scientists recruited 160 adult individuals who were treated for persistent insomnia at a Canadian university hospital sleep center between 2002 and 2005. All the participants were randomly assigned to receive either cognitive behavior therapy alone or cognitive behavior therapy in combination with 10 mg a day of zolpidem (sold under the brand name Ambien by Sanofi-Aventis), taken at bedtime, for an initial six-week therapy, followed by a longer-term, half-a-year treatment. The participants in the zolpidem group were also allowed to take the medication "whenever it was needed" during the six month follow-up period.
The results revealed that in the six-week initial period, both weekly group therapy sessions and nightly medication worked similarly well, and helped nearly 60 per cent of the participants fall asleep more quickly and sleep better and longer. But, the investigators found that in the long-term, Cognitive Behavioral Therapy alone turned out to be the most effective strategy. Six months later, 68 per cent of the CBT-alone group reported significant improvements in their sleep habits, compared to the 42 per cent of those in the combination group.
"When we treat chronic insomnia in adults, we can use cognitive behavioral therapy alone or in combination with medications. This study found an added value to adding medications for the short-term," said Dr. Morin.
Bimonthly individual talk therapy sessions appeared to be most effective against the problematic condition in the follow-up period, where patients could share and address various issues which were contributing to their sleep loss. Throughout the treatment, patients were asked only to sleep in bed and to avoid reading, watching TV or spending time just laying down in bed. They were instructed to get up if not able to fall asleep after twenty minutes and go to bed only when feeling sleepy again. The patients also had to wake up every morning at the same time.
Zolpidem is a medication that is recommended for short time periods. Side effects of the drug include morning drowsiness and hallucinations if unable to sleep right away, and drug dependence is not uncommon. Some individuals even reported to sleepwalking, sleep driving, binge eating and talking while sleeping on the drug.
The study is published in the May 20 edition of the Journal of the American Medical Association.
Tags: Mental Health
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