Psychotherapy is as effective as sleeping pills for treating insomnia, and in some cases it can further reduce nighttime performance anxiety. These are the results of a new study from Laval University published at the end of December in the prestigious journal JAMA Network.
Two stadiums
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“The advantage of psychotherapy is that it can lead to changes in behavior, whereas with sleeping pills, if you continue for a long time, you can have addiction problems and need higher doses” , said Mr. Morin.
The study by psychologist Charles Morin, of Laval University, shows for the first time that psychotherapy is as effective as the sleeping pill zolpidem in treating the functional consequences of insomnia. And these effects persist for more than a year. Of 211 adults with insomnia who participated in the study, half were in remission after an initial six weeks. Cases of refractory insomnia then received other treatments, including a more advanced type of psychotherapy and another sleeping pill, trazodone. “The advantage of psychotherapy is that it can lead to changes in behavior, whereas with sleeping pills, if you continue for a long time, you can have addiction problems and need higher doses” , said Mr. Morin.
Anxiety
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“Sometimes, when you can’t sleep, it becomes an obsession. There is performance anxiety, we have the impression that it is a failure not to be able to sleep,” says Mr. Morin.
While sleeping pills and psychotherapy have similar results in the first stage, in the second stage, psychotherapy has an advantage in reducing anxiety. “Sometimes, when you can’t sleep, it becomes an obsession,” says Mr. Morin. There is performance anxiety, it feels like a failure not to be able to sleep. We’re going to take leave the day after a sleepless night. But just because you don’t sleep well doesn’t mean you can’t work. You can adapt your work to target more difficult tasks when you are more focused. »
Behavior and cognition
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You should avoid screens or stressful activities before sleeping, suggests Mr. Morin.
The psychotherapy of the first part is “behavioral”. “We are targeting sleep habits,” says Mr. Morin. For example, if the patient feels like they are sleeping less than they should, say six hours rather than eight, we suggest they compress their night to six hours. Then, we increase by 20 minutes per day. You should also avoid screens or stressful activities before sleeping. » The psychotherapy of the second part is “cognitive”. “We work on ruminations, obsessions and concerns related to sleep. » Are e-readers part of screens? No because they have blue light filters.
Functional aspects
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“Insomnia also has functional aspects, such as performance during the day, depression or anxiety,” says Mr. Morin.
The aspects of behavior assessed by Mr. Morin are depressive symptoms, anxiety, fatigue and more generally “functional” aspects at work and in social life. “We have shown in the past that psychotherapy is as effective as sleeping pills in treating aspects solely related to sleep and insomnia,” says Mr. Morin. But insomnia also has functional aspects, such as daytime performance, depression or anxiety. » In some cases, a patient may have improved sleep, but still experience functional impacts from their insomnia.
Next steps
PHOTO OLIVIER PONTBRIAND, LA PRESSE ARCHIVES
“It seems that insomnia linked to a lot of anxiety is more likely to be treated with cognitive-behavioral psychotherapy,” says Morin.
Emerging research shows that the type of insomnia could explain the success of a psychotherapeutic or medication approach. “It seems that insomnia linked to a lot of anxiety is more likely to be treated with cognitive-behavioral psychotherapy,” says Morin. There are also new medications that are less addictive, as well as approaches that rely on intermittent use of sleeping pills to avoid addiction, says the specialist.