Taking America Off Drugs: Why Behavioral Therapy is More Effective for Treating ADHD, OCD, Depression, and Other Psychological Problems

9. Health Concerns, Head to Toe

Chapter 9 Health Concerns, Head to Toe SLEEP’S SEDUCTION The “news” of March 29, 2005, was something that most Americans knew already—many Americans are not getting enough sleep. But what made the known news was that according to the National Sleep Foundation the problem had reached epidemic proportions. One in 6 Americans was getting less than 6 hours of sleep a night, a 33% increase since the foundation’s first report in 1998. Furthermore, these sleep problems led to other problems, as 30% reported that sleep deprivation contributed to relationship problems, and 20% reported less sex as a result. Despite these problems, 70% of respondents did not talk to their doctors about their sleep difficulties (Zwillich, 2005a). But there was no need to worry for these sleepy souls. The very evening newscasts that announced the sleeplessness epidemic were supported by frequent advertisements for Ambiem, a sleeping pill! How convenient—too convenient. The National Sleep Foundation is not funded by a bunch of sleepy sufferers who organized to fight for their right to sleep through the night. No, the foundation is funded by the makers of sleeping pills. A sleep research finding more newsworthy than the foundation’s selfserving survey had appeared less than 1 year earlier. But because the results could not be used to turn profits, that finding was not promoted. In “Cognitive Behavior Therapy [CBT] and Pharmacotherapy for Insomnia,” Gregg Jacobs, PhD and coresearchers from the Sleep Disorders Center of the Beth Israel Medical Center and Harvard 123 Medical School directly compared Ambiem to CBT for the treatment of chronic insomnia. The results of the comparison were clear and telling: CBT was the most sleep effective intervention; it produced the greatest changes in sleep-onset latency and sleep efficiency , yielded the largest number of normal sleepers after treatment, and maintained therapeutic gains at long-term follow-up. The combined treatment provided no advantage over CBT alone, whereas pharmacotherapy produced only moderate improvements during drug administration and returned measures toward baseline after drug use discontinuation . . . . These findings sugggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia. Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large number of patients with insomnia. (Jacobs, Pace-Schott, Stickgold, & Otto, 2004, 1888) Patients in the CBT group had a 44% reduction in the time it took to fall asleep. The drugged patients had only a 29% reduction, which was lost when medication was discontinued. According to Jacobs, “Sleeping pills are the most frequent treatment for insomnia, yet CBT techniques clearly were more successful in helping the majority of study participants to become normal sleepers. The pills were found to be only moderately effective compared with CBT, and lost their effectiveness soon after they were discontinued” (quoted in Rosack, 2004, p. 32). Not surprisingly, then, the outcome of comparing the drug approach to the behavioral approach for the treatment of insomnia is the same outcome of every other comparison between drugs and behavioral therapy for behavioral problems—people derive significantly greater benefits from the behavioral approach, the behavioral approach should be considered a first-line intervention, and more widespread recommendations for its use could improve the quality of life for many. But, as with other problems, it is easier to pop a sleeping pill than it is to go through CBT. For insomnia, CBT’s key component is simple “sleep hygiene.” Sleep hygiene includes such basic life changes as regular exercise not closer than 6 hours before bed; being in bed for only 124 TAKING AMERICA OFF DRUGS sleeping and sex; getting out of bed if one does not fall asleep in about a half hour and performing an activity such as reading or crossword puzzles and returning to bed only when sleepiness returns; not checking the clock while in bed, and even removing it from the bedroom (people with sleep problems often spend more time checking the clock and worrying about sleep loss than they spend sleeping); getting out of bed at the same time every day, regardless of what time one goes to sleep; and not napping, or limiting naps to early in the day for 1 hour or less. People who have sleep problems often take long naps to “catch up...