Is Psychotherapy Or Medication Therapy Best For Treating Chronic Insomnia

Question: Is Psychotherapy Or Medication Therapy Best For Treating Chronic Insomnia

For some time now many doctors and researchers have debated the benefits of psychotherapy vs. "pharmacotherapy," or the use of medications, to treat insomnia. While some studies argue that certain forms of psychotherapy like cognitive-behavior therapy may be ideal for treating chronic insomnia, still others argue medication therapy or “pharmacotherapy” is better for treating chronic insomnia. That leaves you wondering, “Which is it?”

Answer: The answer may be “both” at least according to studies published in Psychotherapy and Psychosomatics and The Journal Of Clinical Psychiatry. Researchers for some time now have investigated the long-term outcomes of both conventional medication therapy and psychotherapy for treating patients with chronic insomnia. In one study, participants were provided with four treatment sessions over an 8-week period. The results of the study suggest that a combination of cognitive behavior therapy, a form of psychotherapy, and medication therapy, including the use of sleep aids or benzodiazepines one hour prior to bedtime, may help patients sleep better than patients receiving one or the other treatment. Still other studies however, suggest that psychotherapy may be the best choice for long-term treatment of chronic insomnia.

Does this mean that all patients should investigate the benefits of behavior therapy versus medication therapy? Not necessarily. Research does support the use of medications to treat some forms of insomnia. It also supports the use of psychotherapy, especially when treating a patient with chronic insomnia. You may find that you benefit in the long-term by using psychotherapy alone. Key to your good health and your ability to sleep is a frank discussion with your doctor, who can help you decide what the best course of action is in your case. Insomnia is not a one size fits all disorder. Many of the studies that support one option or another are quite small, and because of this, you cannot necessarily generalize the results to the public at large. That means what may be true for a small sample population of 77 people may not be true for the 1 million or more people that suffer from insomnia. A larger randomized comparison might provide more information that doctors or other researchers could generalize to the public at large. You doctor can help you sort the fact from fiction when it comes to deciding on the best treatment course for you. Fortunately, for now, the job of deciding what treatment choice is best for "the population at large" is not up to you. If it were, you would likely spend even more sleepless nights researching the pros and cons of psychotherapy versus medication for treating your insomnia. For now, remember to concentrate solely on your health, and your ability to overcome insomnia.

If you or someone you know suffers from chronic or primary insomnia, it may be in your best interests to ask your doctor about the many types of psychotherapy available. Some people may find medication therapy is just what they need to treat insomnia, especially if they suffer from acute insomnia or short-term insomnia. Other patients may realize more lasting benefits by participating in cognitive behavioral therapy to treat insomnia. And, still others likely will benefit from both. As science and psychology continue to expand, most consumers will continue to find that more than one form of therapy may help resolve chronic insomnia.

Sources:

Krystal AD. The changing perspective of chronic insomnia management. J Clin Psychiatry. 2004;65:20-25.

Otto, M.W. PhD. Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia. Psychotherapy Psychosom, 2006 Jun: 75, p.220.

Roth T, Walsh JK, Krystal A, Wessel T, Roehrs TA. An evaluation of the efficacy and safety of eszopiclone over 12 months in patients with chronic primary insomnia. Sleep Med. 2005;6:487-495.