If worrying about why you can’t sleep at night is keeping you awake, you’re not alone. Last year, 49 million Americans shelled out $4.5 billion to help them fall or stay asleep. The prescription sleeping meds market has been growing like kudzu since the first generation of pills became popular in the ’70s. These drugs, with names like Halcion and Restoril, belonged to a group of compounds classified as benzodiazepines, which had been used primarily to treat anxiety. They were followed by the non-benzodiazepines — Ambien, Sonata and Lunesta, known as the “Z” drugs. Their main advantage? Since they didn’t linger as long in the body, they weren’t as likely to produce grogginess and sluggishness as side effects. The latest wonder pill is Rozerem, which claims to be a radical improvement because it eliminates the morning-after hangover feeling other pills can leave.
Unfortunately, a night’s sleep isn’t cheap. Z pills sell for $3 to $4 each, and may not be worth that. A meta-analysis of 24 controlled sleeping pill studies by the National Institutes of Health found that these sleep aids take you to dreamland just 12.8 minutes faster than placebos, and increase your total sleep time by only 11.4 minutes. As Karl Doghramji, head of the Sleep Clinic at Thomas Jefferson Hospital, says, “When you look at the data, the effects of the pills are fairly modest.”
Why, then, are they so popular? One reason, suggests Doghramji, is their amnesiac effect. “All these drugs [except Rozerem] work on brain receptors that produce mild amnesia. If you’ve spent the night tossing and turning and looking at the ceiling, it’s a relief to wake up without remembering that."
So if pills don’t work, what does? “For chronic insomnia that’s not related to psychiatric or medical problems, there’s no question that cognitive behavior therapy is the way to go,” says Doghramji. In study after study comparing sleeping pills to CBT, therapy is the clear winner. One report published in the Archives of Internal Medicine compared CBT to Ambien. In 63 cases, the effects of the pills faded as soon as they were discontinued, but patients who’d had short-term CBT were still sleeping soundly a year after their therapy ended. Alan Pack, director of the Sleep Centers at the University of Pennsylvania, says CBT works because it treats the core problem, not the symptom. “People with insomnia tend to have higher anxiety scores,” he says. “Their wake system is overactive, and they get anxious when they hit the pillow. CBT addresses that.”
The goal of CBT is to reduce stress about sleep, so that people get less hysterical at the prospect of a wakeful night. “What we do is twofold,” says Judy Beck, director of the Beck Institute in Bala Cynwyd and daughter of Aaron Beck, the father of cognitive therapy. “We teach good sleep hygiene, along with some relaxation techniques, and then we deal with sleep anxiety. People have to learn that it isn’t a major catastrophe to have a restless night. The more we can relieve the general stress about sleep, the calmer they become, and the less they worry when the light goes out.”
Unfortunately, Beck says, public awareness of CBT as a cure for insomnia is still rather limited. We’re a nation addicted to the instant rewards of pill-popping. And that’s too bad, because you’ll never rid yourself of insomnia with the contents of a bottle.