In Search of Sleep

It happens two or three times a week. I get in bed, turn off the light and wait to fall asleep ... and wait ... and wait. It might be two or three hours before I drop off. And even then, I might wake up a couple of hours later and go through the whole thing again. I'm not alone, either. According to the National Sleep Foundation, about 60% of U.S. adults have insomnia every few days, and about a third go through this torment every night of their lives. I've been thinking more and more about those seductive commercials for Ambien, the pill that promises a full night of blissful sleep with few side effects.

Getting a prescription might not be the best idea, though, says Gregg Jacobs, an insomnia expert with the Sleep Disorders Center at Boston's Beth Israel Deaconess Medical Center. It isn't that Ambien doesn't work. But in a study published last week in the Archives of Internal Medicine, Jacobs and his colleagues show that another treatment, called cognitive behavior therapy, or CBT, works better.

"Drugs like Ambien get you to sleep," says Jacobs, "but they don't get at stress and anxiety, which are often the underlying cause of insomnia." Once you're off the drug, insomnia usually returns with a vengeance. In his placebo control study, a relatively brief course of CBT, lasting about 2 1/2 hours over six weeks, showed no such problem.

As Jacobs explains in his book Say Goodnight to Insomnia (Henry Holt), CBT teaches tricks that insomnia experts have been recommending for years: get up at the same time every morning; use your bed for sleep only, not for reading or TV (sex is O.K., thank goodness). But CBT also teaches relaxation techniques and helps patients unlearn myths about sleep that contribute to anxiety. For example, don't tense up at the thought that you won't get a full eight hours — plenty of people get by on less. If you worry that lack of sleep is bad for your health, it's usually not true. And if you fret about doing badly on the job or on a test the next day, the truth, says Jacobs, is that insomniacs handle sleep deprivation better than most.

The one advantage of Ambien or Sonata (another safe, effective sleeping pill), says Jacobs, is that CBT takes a few weeks to kick in, and the drugs can help bridge that gap.