The investigators say their study findings show that counseling, in the form of cognitive behavioral therapy, should replace drugs as the insomnia treatment of choice.
‘You don’t have to live with insomnia, and the most effective treatments are non-drug,’ said lead study author Dr. Gregg D. Jacobs, an insomnia specialist at Beth Israel Deaconess Medical Center in Boston.
When applied to insomnia, cognitive behavioral therapy aims to change people’s thoughts and behaviors regarding sleep. In short, it addresses the roots of a person’s sleep difficulties, Jacobs told Reuters Health.”
This comes as no surprise to those of us who consult to patients and their doctors about sleep disorders. Even when medication is prescribed, educating and counseling the insomniac on “sleep hygiene” measures, as they used to be called before CBT became such a buzzword, was de rigeur. The potential for a good night’s sleep is very sensitive to assumptions and expectations with which a person approaches bedtime, as well as certain controllable physiological parameters that ‘set the internal clock’. And most sleep medications are not only limited by the development of tolerance to their soporific effects (tolerance is the phenomenon whereby a given dosage becomes ineffective and the user needs more and more to achieve the same effect) but dependency-induced rebound insomnia, so that after some time on sleep medications, the insomniac not only does not sleep well if they skip their meds but they do not sleep well even if they continue to take them, and will often have even more difficulty when they go off the medication than if they had never taken it in the first place. Furthermore, medications that put someone to sleep, or keep them there, usually have effects more broadly on cerebral functions beyond affecting the sleep-wakefulness circuitry.
