The answer may be to restrict time in bed, perhaps to just six hours of sleep, writes Dr. Matthew Walker in Why We Sleep.  

“By keeping [insomnia] patients awake for longer, we build up a strong sleep pressure. Under this heavier weight of sleep pressure, patients fall asleep faster, and achieve a more stable, solid form of sleep across the night,” he writes. “Upon reestablishing a patient’s confidence in this regard, time in bed is gradually increased.”

Yesterday, we looked at the results of research done by leading medical doctors and researchers who examined all published studies on the impact of sleeping pills. “There was no objective benefit of these sleeping pills beyond that which a placebo offered,” Matthew writes. “The committee concluded the report by stating that the effect of current sleeping medications was ‘rather small and of questionable clinical importance.'”

However, there is another approach for improving sleep and combating insomnia that utilizes Cognitive Behavioral Therapy for Insomnia or CBT-I. This method begins initially with restricting time in bed, which results in people becoming sleepier, which allows them to fall asleep. “In this way, a patient can regain their psychological confidence in being able to self-generate and sustain healthy, rapid, and sound sleep, night after night: something that has eluded them for months if not years,” Matthew observes.

These results have been duplicated in many studies worldwide, which demonstrate “CBT-I is more effective than sleeping pills in addressing numerous problematic aspects of sleep for insomnia sufferers,” Matthew writes. “CBT-I consistently helps people fall asleep faster at night, sleep longer, and obtain superior sleep quality by significantly decreasing the time spent awake at night.”

And the positive impact persists after participants stop working with a sleep therapist.

“So powerful is the evidence favoring CBT-I over sleeping pills for improved sleep across all levels, and so limited or nonexistent are the safety risks associated with CBT-I (unlike sleeping pills), that in 2016, the American College of Physicians made a landmark recommendation,” notes Matthew. “CBT-I must be used as the first-line treatment for all individuals with chronic insomnia, not sleeping pills.”

2: Matthew contrasts this approach with the unintended consequences of sleeping pills, which can result in a “vicious cycle” for the person taking the medication. Sleeping medications bring about several “unwanted side effects, including next-day grogginess, daytime forgetfulness, performing actions at night of which [we] are not conscious,” writes Matthew, “and slowed reaction times during the day that can impact motor skills, such as driving.

“The waking grogginess can lead people to reach for more cups of coffee or tea to rev themselves up with caffeine throughout the day and evening. That caffeine, in turn, makes it harder for the individual to fall asleep at night, worsening the insomnia.

“In response, people often take an extra half or whole sleeping pill at night to combat the caffeine, but this only amplifies the next-day grogginess from the drug hangover,” Matthew notes. “Even greater caffeine consumption then occurs, perpetuating a possible downward spiral.”

3: Another challenge occurs when someone stops taking sleeping pills which can result in “rebound insomnia. When individuals stop taking these medications, they can suffer worse sleep, sometimes even worse than the poor sleep that led them to seek out sleeping pills to begin with,” Matthew writes. “When the drug is stopped, there can be a withdrawal process, part of which involves an unpleasant spike in insomnia severity.”

This then can result in people going back to taking the drugs. “Few people realize that this night of severe insomnia, and the need to start retaking the drug, is partially or wholly caused by the persistent use of sleeping pills to begin with.”

The best advice (as always)? Consult with our doctor.

More tomorrow.


Reflection: Are there people I know who are taking sleeping pills?

Action: Share this information with them.

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