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Daniel E.

daniel@psychlinks.ca
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Meditation, Cognitive Behavioral Therapy Treat Insomnia Without Drugs
By Jennifer Warner
WebMD Health News

Reviewed by Louise Chang, MD

June 9, 2009 -- Changing bad sleep habits and clearing the mind with meditation may offer drug-free alternatives to traditional insomnia treatments.

Two new studies suggest that cognitive behavioral therapy to change people’s attitudes and actions about sleep and using meditation to encourage relaxation can help insomniacs get a better night’s sleep without pills.

Researchers say that contrary to popular belief, insomnia is not a nighttime-only affliction but a 24-hour problem of hyperarousal. By teaching people how to relax and clear their minds during the day, they sleep better at night.

"Results of the study show that teaching deep relaxation techniques during the daytime can help improve sleep at night," says researcher Ramadevi Gourineni, MD, director of the insomnia program at Northwestern Memorial Hospital, in a news release.

Meditation to Treat Insomnia

Gourineni’s study examined the effectiveness of practicing meditation as an insomnia treatment in 11 people with insomnia.

The participants were divided into two groups. One group was trained in kriya yoga, in which meditation is used to focus internalized attention, and the other received general health education.

Two months later, the results showed that the meditation group experienced improvements in sleep quality and quantity, according to their sleep diaries. They also took less time to fall asleep, woke fewer times, and had fewer symptoms of depression.

Although the effects and study size were small, researchers say the findings suggest that meditation may be an effective alternative insomnia treatment.

Cognitive-Behavioral Therapy Tames Insomnia

The second, larger study looked at the effects of a cognitive behavioral therapy-insomnia (CBT-I) program designed to treat insomnia in 115 people with insomnia. The program included evaluating the person’s habits, attitudes, and knowledge about sleep.

During the treatment sessions, participants learned about sleep scheduling, creating the proper environment for sleep, reducing stimuli that may interfere with sleep, relaxation training, and mindfulness training.

"CBT-I teaches strategies to 'reset' the bodily systems that regulate sleep," researcher Ryan Wetzler, PsyD, of Sleep Medicine Specialists in Louisville, Ky., says in a news release. "Since these systems also play a role in regulation of mood, pain, and other bodily processes, skills developed through CBT-I may also have a positive impact on mood, anxiety, pain, and other associated medical or psychiatric conditions."

The results showed that 50%-60% of those whose main insomnia symptom was trouble falling asleep, staying asleep, or both experienced improvement. Those who completed five or more cognitive behavioral therapy sessions also had improvement in other sleep quality measurements and needed less medication for their insomnia.
 

Daniel E.

daniel@psychlinks.ca
Administrator
Another study showing the benefits of CBT for insomnia:

Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent Insomnia
JAMA

May 20, 2009

A Randomized Controlled Trial

Charles M. Morin, PhD; Annie Valli?res, PhD; Bernard Guay, MD; Hans Ivers, PhD; Jos?e Savard, PhD; Chantal M?rette, PhD; C?lyne Bastien, PhD; Lucie Baillargeon, MD

Context Cognitive behavioral therapy (CBT) and hypnotic medications are efficacious for short-term treatment of insomnia, but few patients achieve complete remission with any single treatment. It is unclear whether combined or maintenance therapies would enhance outcome.

Objectives
To evaluate the added value of medication over CBT alone for acute treatment of insomnia and the effects of maintenance therapies on long-term outcome.

Design, Setting, and Patients Prospective, randomized controlled trial involving 2-stage therapy for 160 adults with persistent insomnia treated at a university hospital sleep center in Canada between January 2002 and April 2005.

Interventions Participants received CBT alone or CBT plus 10 mg/d (taken at bedtime) of zolpidem for an initial 6-week therapy, followed by extended 6-month therapy. Patients initially treated with CBT attended monthly maintenance CBT for 6 months or received no additional treatment and those initially treated with combined therapy (CBT plus 10 mg/d of zolpidem) continued with CBT plus intermittent use of zolpidem or CBT only.

Main Outcome Measures Sleep onset latency, time awake after sleep onset, total sleep time, and sleep efficiency derived from daily diaries (primary outcomes); treatment response and remission rates derived from the Insomnia Severity Index (secondary outcomes).

Results Cognitive behavioral therapy used singly or in combination with zolpidem produced significant improvements in sleep latency, time awake after sleep onset, and sleep efficiency during initial therapy (all P<.001); a larger increase of sleep time was obtained with the combined approach (P = .04). Both CBT alone and CBT plus zolpidem produced similar rates of treatment responders (60% [45/75] vs 61% [45/74], respectively; P = .84) and treatment remissions (39% [29/75] vs 44% [33/74], respectively; P = .52) with the 6-week acute treatment, but combined therapy produced a higher remission rate compared with CBT alone during the 6-month extended therapy phase and the 6-month follow-up period (56% [43/74 and 32/59] vs 43% [34/75 and 28/68]; P = .05). The best long-term outcome was obtained with patients treated with combined therapy initially, followed by CBT alone, as evidenced by higher remission rates at the 6-month follow-up compared with patients who continued to take zolpidem during extended therapy (68% [20/30] vs 42% [12/29]; P = .04).

Conclusion In patients with persistent insomnia, the addition of medication to CBT produced added benefits during acute therapy, but long-term outcome was optimized when medication is discontinued during maintenance CBT.
 
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