Wednesday, March 17, 1999 Published at 10:11 GMT
Behaviour cure for sleepless nights
Many people - particularly the elderly - have trouble sleeping
Chronic insomniacs would fare better if they kept the bed for sleep and sex rather than popping sedatives, according to research.
A Canadian study found that taking sleeping pills worked in the short-term, but only changing their behaviour was effective over a long period.
Elderly people are more at risk of insomnia, with up to a quarter of Americans over 65 estimated to suffer from insomnia.
This is defined as trouble falling asleep, waking frequently in the night and waking up early in the morning without being able to get back to sleep.
Less than 15% get any treatment at all, although insomnia can cause extreme fatigue during the day, impaired functioning, reduced quality of life and increase the risk of suffering from clinical depression or being admitted to a nursing home.
Drugs vs therapy
The study, led by Charles Morin of the Université Laval in Quebec and funded by the National Institute of Mental Health, examined 78 adults with an average age of 65 who suffered from chronic and primary insomnia.
Some were given the sedative temazepam, others behavioural therapy, some a combination of the two and the rest a placebo.
They received the treatment for eight weeks and were followed up over a two-year period.
The researchers found that drug and behavioural therapy combined was most effective in helping people to fall and stay asleep.
But behavioural therapy scored higher than drugs.
Fifty-five per cent of sufferers who were treated with behavioural therapy noted an improvement in their sleep patterns, compared with 46.5% of those on temazepam.
The behavioural therapy involved weekly therapy sessions lasting 90 minutes.
Patients were told, for example, to stop using their bed for activities such as eating or reading and simply to use it for sleeping and sex.
They were also advised to get out of bed and go to another room if they did not manage to fall asleep within 15 to 20 minutes of going to bed and to get up at the same time in the morning each day, regardless of how much sleep they had had.
In addition, they were taught how diet, alcohol, caffeine, exercise and environmental factors affect sleep patterns.
"Although such behavioural intervention is more time consuming than drug therapy, it is worth the investment because therapeutic gains are well maintained."
In a related editorial in the JAMA, Dr Charles Reynolds and his team from the University of Pittsburgh says that the Morin study shows the need for better assessment of chronic insomnia.
"The dilemma for patients and their physicians is that insomnia complaints tend to be chronic and recurring; hence, long-term disease management strategies are greatly needed," they write.