Cognitive Behavioral Therapy Appears More Effective Than Sleep Medication For Treating Insomnia
29 Jun 2006
Patients with insomnia who implemented cognitive behavioral therapy interventions such as relaxation techniques had greater
improvement in their sleep than patients who received the sleep medication zopiclone, according to a study in the June 28 issue of
JAMA.
Insomnia is usually defined as subjective complaints of poor sleep accompanied by impairment in daytime function. It is common in
people aged older than 55 years (9 percent-25 percent are affected) and is associated with reduced quality of life, depression, and
more physician visits. Despite these links to individuals' lives and societal costs, most people with chronic insomnia-up to 85 percent-
remain untreated, according to background information in the article. Two-thirds of individuals with insomnia report having poor
knowledge of available treatment options, and as many as one fifth resort to either untested over-the-counter medications or alcohol in
attempts to improve their condition. Among primary care physicians, the treatment of choice for insomnia has commonly been
prescription medication. Cognitive behavioral therapy (CBT) is the most widely used psychological intervention for insomnia. No
studies have compared the newer non-benzodiazepine sleep medications with nonpharmacological treatments.
Borge Sivertsen, Psy.D., of the University of Bergen, Norway, and colleagues conducted a randomized controlled trial between
January 2004 and December 2005 to compare the short- and long-term clinical efficacy of CBT and the non-benzodiazepine sleep
medication zopiclone. The trial included 46 adults (average age 60.8 years; 22 women) with chronic primary insomnia. The
participants received either the CBT intervention (information on sleep hygiene, sleep restriction, stimulus control, cognitive therapy,
and progressive relaxation technique; n = 18), sleep medication (7.5 mg zopiclone each night; n = 16), or placebo medication (n = 12).
All treatment duration was 6 weeks, and the 2 active treatments were followed up at 6 months. Clinical polysomnographic data and
sleep diaries were used to determine total wake time, total sleep time, sleep efficiency, and slow-wave sleep (only assessed using
polysomnography [PSG; monitoring of physiological activity during sleep]).
Using PSG testing, the total time spent awake during the night for the CBT group improved significantly more than both the placebo
group at 6 weeks and the zopiclone group at both 6 weeks and 6 months. The zopiclone group did not differ significantly from the
placebo group. Total wake time at 6 weeks was reduced 52 percent in the CBT group compared with 4 percent and 16 percent in the
zopiclone and placebo groups on PSG testing, respectively. On average, participants receiving CBT improved their PSG-registered
sleep efficiency by 9 percent at posttreatment, compared with a decline of 1 percent in the zopiclone group, a difference that the
authors stated was both statistically and clinically significant.
Total sleep time measured using both PSG and sleep diary increased significantly in the CBT group at 6 months compared with 6
weeks. The zopiclone group showed no significant change at 6 months on PSG, maintaining improvements seen at 6 weeks.
Comparing the 2 active treatment conditions, total wake time, sleep efficiency, and slow-wave sleep were all significantly better in the
CBT group than in the zopiclone group as assessed using PSG; total sleep time was not significantly different .
"… the present findings have important implications for the clinical management of chronic primary insomnia in older adults. Given the
increasing amount of evidence of the lasting clinical effects of CBT and lack of evidence of long-term efficacy of hypnotics, clinicians
should consider prescribing hypnotics only for acute insomnia. At present, CBT-based interventions for insomnia are not widely
available in clinical practice, and future research should focus on implementing low-threshold treatment options for insomnia in
primary care settings. As recently demonstrated by Bastien et al, telephone consultations and CBT-based group therapy for younger
patients with insomnia produced equally significant improvements as individual therapy sessions. In another study, CBT delivered via
the Internet in a self-help format showed significant improvements in individuals with chronic insomnia," the authors write. "Finally,
future research should seek to identify which single factors in the CBT regimen produce the best results and to what extent booster
sessions at 1 to 2 years after initial treatment may be necessary to maintain improvements."
###
JAMA. 2006;295:2851-2858
TOP 10 foods for a good nights sleep
What is the secret to getting a solid 7 to 8 hours of sleep? Head for the kitchen and enjoy one or two of these 10 foods. They relax
tense muscles, quiet buzzing minds, and/or get calming, sleep-inducing hormones - serotonin and melatonin - flowing. Yawning yet?
Bananas. They're practically a sleeping pill in a peel. In addition to a bit of soothing melatonin and serotonin, bananas contain
magnesium, a muscle relaxant.
Chamomile tea. The reason chamomile is such a staple of bedtime tea blends is its mild sedating effect - it's the perfect natural antidote
for restless minds/bodies.
Warm milk. It's not a myth. Milk has some tryptophan - an amino acid that has a sedative - like effect - and calcium, which helps the
brain use tryptophan. Plus there's the psychological throw-back to infancy, when a warm bottle meant "relax, everything's fine."
Honey. Drizzle a little in your warm milk or herb tea. Lots of sugar is stimulating, but a little glucose tells your brain to turn off orexin,
a recently discovered neurotransmitter that's linked to alertness.
Potatoes. A small baked spud won't overwhelm your GI tract, and it clears away acids that can interfere with yawn-inducing
tryptophan. To up the soothing effects, mash it with warm milk.
Oatmeal. Oats are a rich source of sleep - inviting melatonin, and a small bowl of warm cereal with a splash of maple syrup is cozy -
plus if you've got the munchies, it's filling too.
Almonds. A handful of these heart-healthy nuts can be snooze-inducing, as they contain both tryptophan and a nice dose of muscle-
relaxing magnesium.
Flaxseeds. When life goes awry and feeling down is keeping you up, try sprinkling 2 tablespoons of these healthy little seeds on your
bedtime oatmeal. They're rich in omega-3 fatty acids, a natural mood lifter.
Whole-wheat bread. A slice of toast with your tea and honey will release insulin, which helps tryptophan get to your brain, where it's
converted to serotonin and quietly murmurs "time to sleep."
Turkey. It's the most famous source of tryptophan, credited with all those Thanksgiving naps. But that's actually modern folklore.
Tryptophan works when your stomach's basically empty, not overstuffed, and when there are some carbs around, not tons of protein.
But put a lean slice or two on some whole-wheat bread mid-evening, and you've got one of the best sleep inducers in your kitchen.
What if none of these foods help you get your zzz's? Check out your sleep habits with this quick RealAge test to find out what?s
keeping you up at night. http://www.realage.com/health_guides/RLS/intro.aspx
For an extra treat, here's the ultimate sleep-inducing snack...
Lullaby Muffins
Makes 12 low-fat muffins
Between the bananas, the whole wheat, and the honeyed touch of sweetness, these muffins are practically an edible lullaby.
· 2 cups whole-wheat pastry flour
· 1/2 teaspoon salt
· 1 tablespoon baking powder
· 2 large, very ripe bananas
· 1/3 cup applesauce
· 1/4 cup honey
· 1/2 cup milk or soymilk
Preheat oven to 350F. In a large bowl, combine the flour (make sure it's whole-wheat pastry flour or you'll produce golf balls, not
muffins), salt, and baking powder. In a blender, puree the bananas; add the applesauce, honey, and milk. Blend well. Pour the banana
mixture into the dry ingredients and stir until just moistened. Line muffin tins with paper muffin cups, pour in batter, and bake 30
minutes or until tops are lightly brown and slightly springy.
Nutrition Facts
Per serving: 119 calories; 1g fat; 2.5g protein; 27g carbohydrates; 10g sugars; 133mg sodium; 3g fiber; 35mg magnesium
29 Jun 2006
Patients with insomnia who implemented cognitive behavioral therapy interventions such as relaxation techniques had greater
improvement in their sleep than patients who received the sleep medication zopiclone, according to a study in the June 28 issue of
JAMA.
Insomnia is usually defined as subjective complaints of poor sleep accompanied by impairment in daytime function. It is common in
people aged older than 55 years (9 percent-25 percent are affected) and is associated with reduced quality of life, depression, and
more physician visits. Despite these links to individuals' lives and societal costs, most people with chronic insomnia-up to 85 percent-
remain untreated, according to background information in the article. Two-thirds of individuals with insomnia report having poor
knowledge of available treatment options, and as many as one fifth resort to either untested over-the-counter medications or alcohol in
attempts to improve their condition. Among primary care physicians, the treatment of choice for insomnia has commonly been
prescription medication. Cognitive behavioral therapy (CBT) is the most widely used psychological intervention for insomnia. No
studies have compared the newer non-benzodiazepine sleep medications with nonpharmacological treatments.
Borge Sivertsen, Psy.D., of the University of Bergen, Norway, and colleagues conducted a randomized controlled trial between
January 2004 and December 2005 to compare the short- and long-term clinical efficacy of CBT and the non-benzodiazepine sleep
medication zopiclone. The trial included 46 adults (average age 60.8 years; 22 women) with chronic primary insomnia. The
participants received either the CBT intervention (information on sleep hygiene, sleep restriction, stimulus control, cognitive therapy,
and progressive relaxation technique; n = 18), sleep medication (7.5 mg zopiclone each night; n = 16), or placebo medication (n = 12).
All treatment duration was 6 weeks, and the 2 active treatments were followed up at 6 months. Clinical polysomnographic data and
sleep diaries were used to determine total wake time, total sleep time, sleep efficiency, and slow-wave sleep (only assessed using
polysomnography [PSG; monitoring of physiological activity during sleep]).
Using PSG testing, the total time spent awake during the night for the CBT group improved significantly more than both the placebo
group at 6 weeks and the zopiclone group at both 6 weeks and 6 months. The zopiclone group did not differ significantly from the
placebo group. Total wake time at 6 weeks was reduced 52 percent in the CBT group compared with 4 percent and 16 percent in the
zopiclone and placebo groups on PSG testing, respectively. On average, participants receiving CBT improved their PSG-registered
sleep efficiency by 9 percent at posttreatment, compared with a decline of 1 percent in the zopiclone group, a difference that the
authors stated was both statistically and clinically significant.
Total sleep time measured using both PSG and sleep diary increased significantly in the CBT group at 6 months compared with 6
weeks. The zopiclone group showed no significant change at 6 months on PSG, maintaining improvements seen at 6 weeks.
Comparing the 2 active treatment conditions, total wake time, sleep efficiency, and slow-wave sleep were all significantly better in the
CBT group than in the zopiclone group as assessed using PSG; total sleep time was not significantly different .
"… the present findings have important implications for the clinical management of chronic primary insomnia in older adults. Given the
increasing amount of evidence of the lasting clinical effects of CBT and lack of evidence of long-term efficacy of hypnotics, clinicians
should consider prescribing hypnotics only for acute insomnia. At present, CBT-based interventions for insomnia are not widely
available in clinical practice, and future research should focus on implementing low-threshold treatment options for insomnia in
primary care settings. As recently demonstrated by Bastien et al, telephone consultations and CBT-based group therapy for younger
patients with insomnia produced equally significant improvements as individual therapy sessions. In another study, CBT delivered via
the Internet in a self-help format showed significant improvements in individuals with chronic insomnia," the authors write. "Finally,
future research should seek to identify which single factors in the CBT regimen produce the best results and to what extent booster
sessions at 1 to 2 years after initial treatment may be necessary to maintain improvements."
###
JAMA. 2006;295:2851-2858
TOP 10 foods for a good nights sleep
What is the secret to getting a solid 7 to 8 hours of sleep? Head for the kitchen and enjoy one or two of these 10 foods. They relax
tense muscles, quiet buzzing minds, and/or get calming, sleep-inducing hormones - serotonin and melatonin - flowing. Yawning yet?
Bananas. They're practically a sleeping pill in a peel. In addition to a bit of soothing melatonin and serotonin, bananas contain
magnesium, a muscle relaxant.
Chamomile tea. The reason chamomile is such a staple of bedtime tea blends is its mild sedating effect - it's the perfect natural antidote
for restless minds/bodies.
Warm milk. It's not a myth. Milk has some tryptophan - an amino acid that has a sedative - like effect - and calcium, which helps the
brain use tryptophan. Plus there's the psychological throw-back to infancy, when a warm bottle meant "relax, everything's fine."
Honey. Drizzle a little in your warm milk or herb tea. Lots of sugar is stimulating, but a little glucose tells your brain to turn off orexin,
a recently discovered neurotransmitter that's linked to alertness.
Potatoes. A small baked spud won't overwhelm your GI tract, and it clears away acids that can interfere with yawn-inducing
tryptophan. To up the soothing effects, mash it with warm milk.
Oatmeal. Oats are a rich source of sleep - inviting melatonin, and a small bowl of warm cereal with a splash of maple syrup is cozy -
plus if you've got the munchies, it's filling too.
Almonds. A handful of these heart-healthy nuts can be snooze-inducing, as they contain both tryptophan and a nice dose of muscle-
relaxing magnesium.
Flaxseeds. When life goes awry and feeling down is keeping you up, try sprinkling 2 tablespoons of these healthy little seeds on your
bedtime oatmeal. They're rich in omega-3 fatty acids, a natural mood lifter.
Whole-wheat bread. A slice of toast with your tea and honey will release insulin, which helps tryptophan get to your brain, where it's
converted to serotonin and quietly murmurs "time to sleep."
Turkey. It's the most famous source of tryptophan, credited with all those Thanksgiving naps. But that's actually modern folklore.
Tryptophan works when your stomach's basically empty, not overstuffed, and when there are some carbs around, not tons of protein.
But put a lean slice or two on some whole-wheat bread mid-evening, and you've got one of the best sleep inducers in your kitchen.
What if none of these foods help you get your zzz's? Check out your sleep habits with this quick RealAge test to find out what?s
keeping you up at night. http://www.realage.com/health_guides/RLS/intro.aspx
For an extra treat, here's the ultimate sleep-inducing snack...
Lullaby Muffins
Makes 12 low-fat muffins
Between the bananas, the whole wheat, and the honeyed touch of sweetness, these muffins are practically an edible lullaby.
· 2 cups whole-wheat pastry flour
· 1/2 teaspoon salt
· 1 tablespoon baking powder
· 2 large, very ripe bananas
· 1/3 cup applesauce
· 1/4 cup honey
· 1/2 cup milk or soymilk
Preheat oven to 350F. In a large bowl, combine the flour (make sure it's whole-wheat pastry flour or you'll produce golf balls, not
muffins), salt, and baking powder. In a blender, puree the bananas; add the applesauce, honey, and milk. Blend well. Pour the banana
mixture into the dry ingredients and stir until just moistened. Line muffin tins with paper muffin cups, pour in batter, and bake 30
minutes or until tops are lightly brown and slightly springy.
Nutrition Facts
Per serving: 119 calories; 1g fat; 2.5g protein; 27g carbohydrates; 10g sugars; 133mg sodium; 3g fiber; 35mg magnesium
| Cognitive Behavior Therapy for Insomnia |
| CBT The Center for Brief Therapy, PC, 10319 Dawson's Creek Blvd, Suite J, Fort Wayne, Indiana, USA 46825 260-969-5583; fax 260-969-5584; email: freemancbt@aol.com |
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