Health & Medicine
But drugs aren't the only way to attack a problem whose source is the brain. As sleep centers multiply, evolving from their academic roots to include freestanding centers and units at private hospitals, many have started offering cognitive-behavioral therapy. In widespread use for treating problems such as obsessive-compulsive disorder, depression, and addiction, this therapy helps a patient recognize fears that are out of proportion and develop tools to gradually erode them, says Edward Stepanski, a clinical psychologist and director of the Sleep Disorders Service and Research Center at Rush University Medical Center in Chicago.
Among those concerns, says Stepanski, is the fear of terrible health and personal consequences if someone doesn't fall asleep right away--a notion reinforced by widely reported studies on the importance of a full night's sleep. The anxiety only reinforces the insomnia. "Lying in bed thinking, 'I'm going to get fired if I don't get to sleep in the next half-hour,' is counterproductive," says Stepanski.
Therapy can also help patients understand that the tactics they may be using with increasing desperation to manage their sleep probably just make matters worse, says Jack Edinger, a clinical psychologist at the Veterans Affairs and Duke University medical centers in Durham, N.C. Naps, for instance, only scramble the body's internal clock, as does trying to catch up on sleep by going to bed earlier or getting up later.
Take an individual who thinks she needs eight hours of sleep every night. In fact, she may need only seven hours, but if she believes otherwise, the quality of her sleep may be disrupted to the point that she's getting just five or six good hours. Edinger would help someone like her work out a schedule that retrains her by establishing the correct amount of sleep she needs and by limiting the time she spends in bed. "We don't give them a lot of extra time to spin their wheels," he says. "It's not rocket science."
Drugs or therapy--which is better? "The question always makes me crazy," Roth says. "If somebody has elevated cholesterol, do you put them on statins or do you change their diet? You put them on a statin, and you say, 'Stop eating pork rinds.' Both things make you better." A study published last year in the Archives of Internal Medicine found that cognitive-behavioral therapy worked better than Ambien and helped patients more in the long term. But therapy isn't right for everyone. It's expensive, and drugs are usually the better choice for short-term problems like jet lag or stress from a death in the family, says Edinger. But drugs have side effects, so if your insomnia has a long history, many specialists suggest trying therapy first.
Whatever causes your insomnia, it can be treated, says Edinger: "Although insomnia can be a chronic disorder, that doesn't mean that the person has to have it forever. It's just that they haven't yet found a way to get over it."
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