This is indicated by the results of a study conducted by researchers at Laval University, published in the Journal of the American Medical Association (JAMA)¹.

Having developed an effective cognitive-behavioral psychotherapy to treat insomniacs, psychologist Charles Morin and his team wanted to know if the use of a sleeping pill could help improve treatment.

They recruited 160 people all suffering from chronic insomnia for 10 years, on average. By definition, a person has this disorder when it takes more than 30 minutes to fall asleep or spends more than 30 minutes awake in the middle of the night, at least three times a week.

With or without a sleeping pill?

For six weeks, all participants took part in weekly cognitive behavioral therapy sessions aimed at changing their habits and beliefs about sleep and insomnia. Some took 10 mg of zolpidem every night – a classic hypnotic sleeping pill – and some did not.

Then, for the next five months, the psychotherapy sessions took place on a monthly basis.

As a result, taking a sleeping pill was found to be effective in combination with psychotherapy, but only for the first six weeks.

During this period, psychotherapy – alone or in combination with the drug – significantly reduced the time needed to fall asleep, as well as the duration of awake periods during the night, while improving quality of sleep.

But in the long term, people in therapy who had taken a sleeping pill only for the first six weeks had the best results: nearly 70% of them experienced complete remission from their chronic insomnia.

In contrast, those who continued to take zolpidem for the next five months showed a 42% remission rate.

Why such a result?

According to Charles Morin, delaying drug withdrawal has the effect of reducing the beneficial effects of psychotherapy.

“We believe that if they no longer have sleeping pills at all after six weeks, patients put more energy into modifying their behavior,” specifies the psychologist-researcher.

According to him, the medication would be especially useful at the beginning of the treatment of chronic insomnia or to treat occasional insomnia associated with transient situations, such as a divorce or a layoff.

For reimbursement of psychotherapy

In Quebec, psychotherapy costs are generally not covered by the health insurance plan.

Also, Mr. Morin hopes that the results obtained in the context of his study will encourage the government to allocate more resources to non-pharmacological treatments to treat insomnia.

“It is all the same paradoxical that the regime covers the price of sleeping pills, but not that of a psychotherapy which is more effective, especially in the long term”, he insists.

He also stresses that the social costs generated by chronic insomnia, especially in terms of absenteeism from work and reduced productivity, are greater than those which would be associated with the psychotherapeutic treatment of this sleep disorder.

Pierre Lefrançois – PasseportSanté.net

1. Morin CM, Vallières A, Guay B, et al, Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent Insomnia: A Randomized Controlled Trial, JAMA, May 20, 2009, vol. 301, No. 19, 2005-2015.