"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 brief course of CBT, lasting about 2.5 hours over six weeks, showed no such problem.
As Jacobs explains in his book Say Goodnight to Insomnia, CBT reintroduces insomnia experts' old tricks: get up at the same time every morning; use your bed for sleep only (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. Don't worry that lack of sleep is bad for your health: it's usually not true. And there's no need to 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, says Jacobs, is that CBT takes a few weeks to kick in, and the drugs can help bridge that gap.