Sleep medications, often called “Z drugs” (Ambien, Lunesta, and Sonata), are the most commonly prescribed insomnia medications worldwide and account for about $285 million in healthcare costs per year in the united states alone. However, a new evaluation of data submitted to the Food and Drug Administration suggest that the effects of these medications are small and their use can be associated with risks. The authors of this new study conclude their report with the statement:
“This study of FDA data shows that Z drugs improve objective and subjective sleep latency compared with placebo, particularly in younger and female patients. The size of this effect, however, is small and needs to be balanced with concerns about adverse effects, tolerance, and potential addiction. The placebo response accounted for about half of the drug response. This suggests that increased attention should be directed at psychological interventions for insomnia.”
What are these psychological interventions? Science has shown that simple changes in sleep schedules, reactions to trouble sleeping, and sleep-related thinking patterns known as Cognitive-Behavioral Treatment for Insomnia (CBT-I; what I call Radical Sleep Transformation training or RST) can reverse brain changes that occur as a result of chronic insomnia and radically transform disrupted sleep patterns in a matter of days. In fact, the American Academy of Sleep Medicine gives cognitive-behavioral treatments for insomnia the HIGHEST POSSIBLE RECOMMENDATION based on research using the MOST POWERFUL SCIENTIFIC METHODS.
Many of the CBT-I methods have been under powerful scientific research and development for over 40 years but remain underused. Studies have shown that changing sleep behaviors in specific ways can literally change the way your brain structures sleep. In fact, in 2005 the National Institutes of Health State-of-the-Science conference concluded that CBT-I is as effective as sleeping pills. Even consumer reports recommends CBT-I in favor of medications for chronic insomnia based on their recent survey and analysis:
“[For] people with persistent, chronic insomnia—three or more nights a week for months—should seek treatment. We advise cognitive behavioral therapy—a form of psychotherapy—that can improve sleep habits, possibly combined with a cautious use of sleeping pills. Research has found this can help relieve chronic insomnia.”
Why are these methods still so underused?
Individual methods of CBT-I were developed and researched in relative isolation beginning in the 1970’s and their power to transform sleep was quickly known. Slowly these methods started to be packaged in various ways and the scientific evidence supporting that power continues to grow to this day. However, there is little money to be made by healthcare systems or providers, let alone large companies by providing CBT-I. On the other hand, drug companies make billions of dollars from selling sleep medications.
It’s not all about the money though. The medical and mental health communities have largely neglected sleep and, until the last 10 years or so, healthcare providers received little to no exposure to information on normal sleep and sleep disorders during their formal training. Although younger providers are beginning to receive more training on how to diagnose and treat sleep problems, sleep continues to be a low priority. Regarding the results of a recent survey of physicians published in the Journal of Clinical Sleep Medicine, the authors stated:
“One-third of generalists…[were] neither systematically nor proactively screening for sleep disorders, and were reluctant to raise the topic….”
“Generalist participants generally did not prioritize discussing sleep disorders. They further demonstrated a lack of understanding of the impact of sleep disorders on patients’ daily living….”
Finally, even if a healthcare provider knows about and is trained in these methods they still have to deal with almighty time. The bottom line is there’s a perception that it’s just so much faster and easier to give (and take) a pill. Although cognitive-behavioral treatments for insomnia are as effective as sleeping pills, they typically take much more time and effort on the part of the healthcare provider and the person struggling with insomnia.
Learn more about how these issues and how they led me to start the Sleep Health Revolution in the post: Frustration and Disillusionment: Why your doctor won’t offer you sleep transformation (…and it’s not their fault)
Huedo-Medina et al. Effectiveness of Non-Benzodiazepine Hypnotics in Treatment of Adult Insomnia: Meta-Analysis of Data Submitted to the Food and Drug Administration. BMJ 2012;345:e8343 doi: 10.1136/bmj.e8343 (Published 17 December 2012)
Morgenthaler et al. Practice Parameters for the Psychological and Behavioral Treatment of Insomnia: An Update. An American Academy of Sleep Medicine Report. SLEEP 2006;29:1415-1419.
National Institutes of Health State of the Science Conference Statement: Manifestations and Management of Chronic Insomnia in Adults June 13-15, 2005. SLEEP 2005;28:1049-1057.
Hayes et al. (Mis) Perceptions and Interactions of Sleep Specialists and Generalists: Obstacles to Referrals to Sleep Specialists and the Multidisciplinary Team Management of Sleep Disorders. Journal of Clinical Sleep Medicine 2012;8:633-642.