Prescription Sleep Aids Not Always Best For Insomniacs

[HuckleB]

http://www.medicalnewstoday.com/medicalnews.php?newsid=40287

[Warpy]

1. Here's the gist:

"The fact is that for most suffering from occasional insomnia, behavioral changes or over-the-counter options are often just as effective and more appropriate."

I'd add to this that an occasional sleepless night is normal. A whole string of them with excessive tiredness during the day needs to get checked out. Chronic, persistent sleeplessness can be a symptom of something worse.

People run into trouble with powerful prescription aids like Ambien (and its disgraced predecessor, Halcion) because they become afraid of getting a poor night's sleep and take the stuff every night to prevent what might not even happen. Real problems happen when they forget they've taken it and take more or they try to combine it with alcohol when the pill loses its effectiveness, which most sleep aids do after the first 3 consecutive nights of use.

I have year round allergies so I stick to Benadryl. Nobody ever developed a Benadryl Jones.

[varkam]

2. Yup...

Besides that and research has shown that behavioral interventions for Txing insomnia are more efficacious (although they take longer, because you actually have to *talk* to the patient...ugh).

[HuckleB]

3. Can you link us to summaries of this research?

Thanks.

[varkam]

4. Sure can.

Lee, Y. (2004). Overview of the Therapeutic Management of Insomnia with Zolpidem. CNS Drugs. 18, 17-23.
Abstract

Lenhart, S.E. & Buysse D.J. (2001). Treatment of insomnia in hospitalized patients. Annals of Pharmacotherapy. 35(11), 1449-1457.
Abstract

Kupfer, D.J. & Reynolds, C.F. III. (1997). Current concepts: management of insomnia. New England Journal of Medicine. 336(5), 341-346.

(Couldn't find an abstract for this one on PubMed).

I can't link to the articles directly, as they're copyrighted - but abstracts courtesy of pubmed. Hope that helps.

[HuckleB]

5. Those don't show efficacy for nonpharm treatments, however.

I was hoping to see links on that.

[varkam]

6. This is the research I'm aware of

It's not included in the abstract, but the Lee paper contains a discussion concerning behavioral interventions and mentions that behavioral intervention is possibly more efficacious. He cited the other two articles as his sources.

But, just doing a quick search on Pubmed....

Abstract 1

"In this meta-analysis of randomized controlled trials (k = 23), moderate to large effects of behavioral treatments on subjective sleep outcomes were found."

Abstract 2

"Nonpharmacologic therapies can also help patients learn how to fall asleep faster and improve sleep quality. It is important for physicians to teach patients good sleep hygiene as part of their treatment. Cognitive-behavioral therapy is effective in the treatment of insomnia, alone and in combination with pharmacotherapy, but finding a qualified provider can be difficult and the patient must be willing to take the time to learn the therapies and wait for them to show effect."

Abstract 3

"Whereas the underlying pathophysiology of PI remains poorly understood, it is widely accepted that a host of cognitive and behavioral factors play important roles in perpetuating this condition. As such, a multi-factorial, cognitive-behavioral therapy (CBT) has emerged as a "treatment of choice" for managing the sleep/wake complaints of PI sufferers."

Hope maybe that's more of what you're looking for

[HuckleB]

8. I read it.

It talks about possibilities, as every research piece does, and nothing more.

[varkam]

9. Sorry to get your panties in a twist.

On edit:

First page of the Lee article (17):

"Several studies have demonstrated the efficacy of alternative treatments, such as cognitive behavioural therapy, but the problem in general practice is not whether the pharmacological approach approach is better than the non-pharmacological approach, but rather how to combine both in an era of managed care."

I admit that I misread the paragraph and made a claim that I couldn't support, and for that I sincerely apologize to you. But, given that behavioral methods don't suffer from the same drawbacks as pharmacological approaches (such as adverse drug reactions, residual effects, tolerance & withdrawal - which has developed in studies longer than 4 weeks with zolpidem) - they do deserve consideration in the treatment of insomnia.

[Ciggies and coffee]

7. Who needs pills when a drink will do the trick?

Many folks I know agree, one feels mighty refreshed after sleeping with dreams of damn good whiskey. And have fun times beforehand instead of imitating the living dead.

Think twice about chugging the bargain basement stuff, though. Hangover. (Cheap vodka seems alright)

I know a lady who used to pop sleeping pills but now has a little wine and chocolate before bed and she wonders why she didn't change sooner.

Much cheaper and does not require a permission slip to buy.

Enjoying some SoCo and a smoke right now, in fact.

[varkam]

10. I know you probably know this, but I'm going to say it anyway...

Alcohol will get you to sleep, but it makes your sleep worse. After about three hours, your body converts the alcohol into sugar (which is a stimulant) and subsequently fragments your sleep. Also, if you're at risk for obstructive sleep apnea, you should avoid alcohol if at all possible before bedtime (it can exacerbates the condition).