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| DO NOT ABRUPTLY DISCONTINUE ANY SLEEP MEDICATION BECAUSE OF THE POSSIBILITY OF WITHDRAWAL REACTIONS |
New research shows that cognitive behavioral therapy is superior to the sleeping pill zopiclone (IMOVANE) for treating both short- and long-term insomnia in adults.
During the course of the research, patients receiving cognitive behavioral therapy improved their sleep efficiency (percentage of time asleep while in bed) from 81.4 percent before treatment to...
| DO NOT ABRUPTLY DISCONTINUE ANY SLEEP MEDICATION BECAUSE OF THE POSSIBILITY OF WITHDRAWAL REACTIONS |
New research shows that cognitive behavioral therapy is superior to the sleeping pill zopiclone (IMOVANE) for treating both short- and long-term insomnia in adults.
During the course of the research, patients receiving cognitive behavioral therapy improved their sleep efficiency (percentage of time asleep while in bed) from 81.4 percent before treatment to 90.1 percent after six months. By comparison, patients in the zopiclone group experienced a decrease in percentage of time asleep from 82.3 percent to 81.9 percent over the course of the study.
Norwegian researchers published the results of the study in the June 28 Journal of the American Medical Association. The study was funded in part by the University of Bergen in Norway and the Norwegian Foundation for Health and Rehabilitation.
Zopiclone is not available for sale in the United States, but it has been available in 85 other countries since 1987. However, the sleeping pill eszopiclone (LUNESTA), which is very popular in the United States, is a very similar drug. Eszopiclone and zopicone include the same drug but zopiclone also includes a mirror image version of eszopiclone, so they are able to be marketed as two separate drugs.
Eszopiclone was listed as a Do Not Use drug in the July 2005 Worst Pills, Best Pills News. More than three million prescriptions were dispensed for this drug in 2005 with sales that exceed $250 million in 2005.
“Cognitive behavioral therapy is a safer, more effective alternative to taking sleeping pills such as zopiclone or eszopiclone,” said Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group.
In Public Citizen’s book Worst Pills, Best Pills, the Health Research Group recommends cognitive behavioral therapy treatments for insomnia that are similar to the ones used in this study. This recommendation is due to evidence that sleeping pills can cause dependence (sometimes inadvertently), daytime sedation, confusion, memory loss, increased risk of an auto accident, poor coordination resulting in falls and hip fractures, impaired learning ability, slurred speech and even death. A detailed description of these risks can be found here or in Public Citizen’s best-selling book Worst Pills, Best Pills.
Clinical trial indicates therapy works best
The Norwegian research used the scientific “gold standard” method for assessing effectiveness — a randomized, placebo-controlled clinical trial. This study involved 46 adults with chronic insomnia, the average age of whom was 60.8 years.
For six weeks, 18 patients received cognitive behavioral therapy, 16 received zopiclone each night and 12 received a placebo. The patients were followed for six months.
The patients who received cognitive behavioral therapy attended six weekly individual treatment sessions. Each of these sessions lasted about 50 minutes and included sleep hygiene education, sleep restriction, stimulus control, cognitive therapy and progressive relaxation techniques. (For more information, see the table that accompanies this article.)
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ELEMENTS OF COGNITIVE BEHAVIORAL THERAPY |
|
|---|---|
| Sleep Hygiene Education | The patient learns about the impact of lifestyle habits such as exercise, diet, and alcohol use and the influence of environmental factors such as light, noise, and temperature. |
| Sleep Restriction | The patient follows a strict schedule of bed times and rising times, restricting patients’ allowed time in bed to the actual sleeping time. The aim is to increase homeostatic sleep drive through partial sleep deprivation. |
| Stimulus Control | Therapists attempt to break associations between the sleep environment and wakefulness by teaching the patient not to engage in bedroom activities incompatible with sleep and to stay in the bedroom only when asleep or sleepy. |
| Cognitive Therapy | Therapists work to identify, challenge, and replace beliefs and fears regarding sleep or the loss of sleep with realistic expectations regarding sleep and daytime function. |
| Progressive Relaxation Technique | The patient is taught how to recognize and control muscular tension through use of exercise instructions on a prerecorded tape or compact disc and to practice the technique at home on a daily basis. |
To compare the effects of cognitive behavioral therapy, zopiclone and the placebo, the researchers measured total wake time, total sleep time and a measurement they called sleep efficiency. Sleep efficiency was defined as the percentage of time each patient was asleep; this percentage was calculated by dividing the actual amount of time spent asleep by the total time spent in bed.
The researchers also measured slow-wave sleep, which is the part of the sleep cycle when brain waves are slow and synchronous. Slow-wave sleep was of particular interest to the researchers because a lack of slow-wave sleep is believed to be responsible for much of the daytime impairment experienced after insomnia patients begin taking sleeping pills. Patients who received cognitive behavioral therapy spent much more time in slow-wave sleep compared with those in other groups, and spent less time awake during the night. Total sleep time was similar in all three groups.
What You Can Do
If you are experiencing insomnia and have tried other means to improve your sleep (see discussion here or in the 2005 edition of Worst Pills, Best Pills, p. 166), ask your physician about a referral to a cognitive behavioral therapy program.
Subscribers to worstpills.org can find a list of drugs that will cause insomnia here.
DO NOT suddenly stop taking sleeping pills without consulting your physician because of the possibility of withdrawal reactions.
