Insomnia: psychotherapy more effective than sleeping pills

Insomnia: psychotherapy more effective than sleeping pills

If you suffer from chronic insomnia, it may be that you have advantage to swap sleeping pills for cognitive-behavioral psychotherapy.

This is indicated by the results of a study conducted by researchers at Laval University, published in the Journal of the American Medical Association (JAMA) 1.

Having developed effective cognitive-behavioral psychotherapy to treat insomniacs, psychologist Charles Morin and his team wanted to know if using a sleeping pill could help improve treatment.

They recruited 160 people, all suffering from chronic insomnia for 10 years, on average. By definition, a person suffers from this disorder when it takes more than 30 minutes to fall asleep or to spend more than 30 minutes awake in the middle of the night, at least three times a week.

With or without sleeping pills?

For six weeks, all participants took part in weekly cognitive-behavioral therapy sessions designed to change their habits and beliefs about sleep and insomnia. Some took zolpidem 10 mg each night - a classic hypnotic sleeping pill - and some did not.

Then, during the next five months, the psychotherapy sessions were held on a monthly basis.

As a result, taking sleeping pills has been effective in combination with psychotherapy, but only for the first six weeks.

During this period, psychotherapy - alone or in combination with the medication - significantly reduced the time required to fall asleep, as well as the duration of awake periods during the night, while improving quality of sleep.

But in the long run, people who had been in therapy and had taken a sleeping pill for only the first six weeks had the best results: nearly 70% of them had a complete remission of their chronic insomnia.

In contrast, those who continued taking zolpidem for the next five months showed a 42% remission rate.

Why such a result?

According to Charles Morin, delaying drug withdrawal has the effect of reducing the beneficial effects of psychotherapy.

"We think that if they do not have sleeping pills at all after six weeks, patients are putting more energy into changing their behavior," says the psychologist-researcher.

According to him, the medication would be especially useful at the beginning of the treatment of the chronic insomnia or to treat the occasional insomnia associated with temporary situations, such as a divorce or a layoff.

For the reimbursement of psychotherapy

In Quebec, psychotherapy fees are generally not covered by the health insurance plan.

As a result, Dr. Morin hopes that the results of his study will encourage the government to allocate more resources to non-pharmacological treatments to treat insomnia.

"It's still paradoxical that the scheme covers the price of sleeping pills, but not that of a psychotherapy that is more effective, especially in the long term," he insists.

He also points out that the social costs generated by chronic insomnia, especially in terms of work absenteeism and lower productivity, are heavier than those associated with the psychotherapeutic treatment of this sleep disorder.

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