As few as half of the prescription sleeping pills are doing the job for about nine million Americans who use them for chronic insomnia, and placebos could work as part of their treatment plans, according to a new study published in the journal Sleep Medicine and reported in Futurity. These findings from the University of Pennsylvania (Penn) disagree sharply with the standard prescribing practices for chronic insomnia treatment (http://www.futurity.org/sleeping-pills-insomnia-975652/?utm_source=feedly&utm_medium=webfeeds).
The researchers advocate for a strategy that reduces sleep drugs and increases placebos, thereby decreasing the amount of medication needed to maintain medication effects over time. It would enable someone to maximize clinical gains in terms of falling and staying asleep while cutting down on side effects and prescription drug costs. Chronic insomnia is defined as "difficulty falling asleep or staying asleep at least three nights a week for at least one month."
According to the Sleep Foundation, there are many causes of insomnia: psychiatric and medical conditions, unhealthy sleep habits, specific substances and/or certain biological factors. Recent research has been exploring insomnia as a problem of the brain being unable to stop being awake. The brain has a sleep cycle and a wake cycle. If one cycle is turned on, the other is turned off. If there is too much wake drive or too little sleep drive, insomnia can be the result (http://sleepfoundation.org/insomnia/content/what-causes-insomnia).
According to the study's senior author, Michael Perlis, associate professor in the University of Pennsylvania's psychiatry department and director of the Penn Behavioral Sleep Medicine Program, "The clinical effects of sleeping pills cannot be relied on to last forever, and long-term use increases risk of psychological dependence and side effects including daytime drowsiness, nausea and muscle pain. Our research found that changing the industry standard for maintenance therapy can maintain treatment responses and lower the incidence of side effects."
The study gave 74 adults with chronic insomnia 10 mg of the sleeping pill zolpidem (Ambien) for four weeks. People who responded to the treatment were randomized into three dosing groups for 12 weeks: nightly dosing with 10 mg or 5 mg, intermittent dosing of 10 mg three to five days a week or partial reinforcement through nightly pills in which half were 10 mg capsules and half were placebo capsules. All three strategies helped people to fall and stay asleep, but those in the intermittent dosing group slept worse and reported more medical symptoms and greater symptom severity than those in the other dosing groups.
As Perlis explained, "When it comes to day-to-day quality of therapeutic outcomes, the strategy we use most frequently, the intermittent doing strategy performed worst. Our findings also go against the standard practice of ‘start low and go slow,' in favor of a ‘start high and go low' dosing strategy in which a patient starts with 10 mg nightly and then when the desired result is reached, switch to either a lower nightly dose or intermittent dosing with placebos on non-medication nights."