Latest Research in Insomnia Treatment
One of the most common difficulties I run into with clients is undiagnosed sleep problems. Insomnia is a symptom of a wide range of psychological conditions including depression, anxiety disorders, substance use disorders, marital conflict and many others. It is also a condition by itself. Many people suffer from sleep problems for years, not realizing that treatments are available, or not knowing what treatment option to pursue.
A recent research article published in the Journal of the American Medical Association (JAMA)1 compared treatments for chronic insomnia. The study sought to determine the best combination of treatment for insomnia when medication and therapy were available. The authors compared Cognitive-Behavior Therapy and medication (Ambien, 10mg) in various combinations as a short-term and a long-term treatment for insomnia to determine the best long-term solutions for sleep difficulty.
They found that the most effective treatment combination out of all of these was a combination of therapy and medication initially, followed by therapy alone.
"Great, so what does this mean for me and my sleep problems?”
When I work with people who suffer from insomnia, I often recommend they go talk with their family doctor about a short-term prescription sleep aid to help re-establish a regular sleep pattern. That can often provide immediate relief while we work on long-term solutions in therapy. There are many, many things that can be done behaviorally to help sleep problems, but sadly people are unaware of how treatable insomnia is. Later in therapy when some of the initial fatigue and distress are relieved, the goal becomes to no longer need the medication and learn the tools needed to achieve normal sleep patterns again.
“So what should I do….the medications or therapy?”
It depends. Come see us for an evaluation so we can give a complete answer. That being said, research tells us that most people benefit from either, but get the most benefit from both (in the right context and with the right goals), and the most lasting results with therapy.
“What about over-the-counter (OTC) sleep aids”?
These are generally not a good option, especially long-term. Some sleep aids tend to interfere with the stages of sleep that you go through at night, and don’t allow you to get the full benefits of natural sleep. They can also have dangerous interactions with other medications, dietary supplements and alcohol. Your family physician can help select a medication that fits your specific problem, and that will not have the long-lasting side effects of many OTC sleep aids. We can help with long term behavioral solutions.
“Great, but what can I do about my sleep right now?”
· Well, let’s start with a few simple sleep hygiene tips that apply to all of us. You brain should associate bed with sleep (well, and intimacy…but that’s another article) Sometimes we associate it with other things as life gets busier (Facebook or work, anyone??)
· If you read or watch TV in bed, try doing that in a chair near you bed, or better yet, another room. It sounds simple, but it helps to re-train your brain to fall asleep when you climb into bed.
· Also, never spend more than 20 minutes in bed awake (tossing and turning). Get up and go do something mildly distracting for 15 minutes and try again. Repeat as many times as it takes.
· As far as eating and drinking go, try to limit your intake within a couple hours of bedtime. If you’re too hungry to sleep, try a light snack. People sometimes ask me “what do my dreams mean”. I usually joke “it depends on what you ate for dinner”.
· No caffeine after noon, until you get your sleep patterns back. Caffeine can stay in your system for over 6 hours.
· Finally, if you like things dark in the morning, try exposing your eyes to sunlight as soon as you can stand it in the morning. Your brain has a chemical “stopwatch” that starts each day when natural light hits your eyes, and triggers the release of hormones that help you fall asleep that night.
And schedule an appointment for a professional sleep evaluation with us. We can help get you moving towards peaceful sleep again!!
Jeremy Bidwell, Ph.D.
M.S. Clinical Psychopharmacology
Heartland Counseling
(630) 365-0899, ext. 106
Charles M. Morin; Annie Vallieres; Bernard Guay; Hans Ivers; Josee Savard; Chantal Merette; Celyne Bastien; Lucie Baillargeon.Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent Insomnia: A Randomized Controlled Trial JAMA. 2009;301(19):2005-2015.
