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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Wednesday, September 29, 2004

    To Sleep: A little bit of therapy is more effective than pills for treating insomnia:

    A handful of therapy sessions does more to help chronic insomniacs get to sleep than the top-selling sleeping pill, according to a new Harvard Medical School study, suggesting that doctors are relying too heavily on medications to treat Americans' increasingly restless nights.

    ...Therapists' advice typically includes such basics as going to bed only when drowsy and getting up at the same time every day, even after a poor night's sleep. The objective is to get insomniacs to unlearn bad habits such as paying bills in bed, worrying instead of sleeping, and keeping themselves awake at night with coffee and strenuous exercise.

    ...In the new study, published in today's edition of the Archives of Internal Medicine, Jacobs and his colleagues divided 63 chronic insomniacs into four groups receiving either Ambien, five therapy sessions, a combination of the two, or a placebo. The patients kept a sleep diary for eight weeks, recording such factors as how long it took to fall asleep and how long they were awake during the night. Researchers acknowledge that such diaries are subjective, but as long as the patient is consistent, they are useful for comparison purposes.

    The researchers found that therapy was most effective for shortening the time it took patients to fall asleep, from 67.9 minutes a night on average to a near-normal 34.1 minutes after eight weeks. The Ambien patients, by contrast, reduced sleep onset time only from 71.5 minutes to 58.7 minutes. Likewise, after therapy patients awoke much less frequently in the night, sleeping 83.5 percent of the time they were in bed compared with 67.2 percent for those taking Ambien.

    This is welcome news. Now, how do I get my patients to believe it? In my experience, people just want "something to help me sleep." I have a hand-out I give patients that describes the steps to improve sleep, which is basically an exercise in retraining bad habits. I go over it with them, but most of the time, they aren't listening. ( I can't tell you how many times I've found it in the trash after they've left.)

    Sometimes, when I'm going over it with them, I feel like the Jack Nicholson character in One Flew Over the Cuckoo's Nest trying to explain Black Jack to the Danny Devito character, who keeps saying over and over "hit me," "hit me," even though he's already at 20. I just keep hearing over and over "give me a pill," "give me a pill." This is one time, though, when I don't give in. In the long run, it does far more harm than good. (Sleeping pills are sedatives, and addictive, no matter what the drug reps say.)

    posted by Sydney on 9/29/2004 08:35:00 AM 0 comments


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