Suffer From Insomnia? Best Insomnia Drug Is Not A Drug, But Rather Cognitive Behavioral Therapy According to Consumer Reports

Do you suffer from insomnia? Have you tried sleeping pills? When a major consumer ratings agency such as Consumer Reports endorses cognitive behavioral therapy over drug treatment for insomnia, it is big news.sleeping dog

In the May 2017 issue of Consumer Reports (CR), there is an article entitled Why the Best Insomnia Treatment Is Not a Drug.  In earlier versions of their articles on sleep and medications for sleep they had reviewed various different sleeping agents but in this updated article they conclude that at best, the newer sleep medications add only between eight and 20 minutes of sleep time, and don’t improve how people feel or operate the next day.

They also reviewed a recent systematic research study by the federal Agency for Healthcare Research and Quality (AHRQ) that compared multiple treatments for sleep problems including drugs, cognitive behavioral therapy, and alternative therapies. This study concluded that cognitive behavioral therapy (CBT) is a safe and effective way to treat insomnia, and is more effective and safer than other treatments.

So Consumer Reports’ Best Buy drug pick is actually not a drug at all! It is Cognitive Behavioral Therapy (CBT). They recommend at least one session and optimally suggest three to six  sessions of CBT with a psychologist.

They also have a good description of how CBT works for insomnia. They explain how you meet with a psychologist and work on changing your beliefs about sleep, as well as changing certain behaviors that may contribute to insomnia. CR also includes a concise chart about bad sleep habits and how to fix them. They have an excellent description of CBT for insomnia here.  If CBT was a sleep medication, promoted by a powerful drug company, it would be a multibillion-dollar product!

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I have previously written about CBT for the treatment of insomnia in the article Cognitive Behavioral Therapy for Insomnia (CBT-I) Outperforms Drugs for Insomnia,   Want to Sleep Better? Get Brief CBT-I Therapy for Sleep Instead of Sleeping Pills, and Good News! You May Be Getting More Sleep Than You Think, Especially If You Suffer Insomnia! so I will just summarize some of the conclusions from those articles.

The bottom line for these articles was that Cognitive Behavioral Therapy for insomnia was safe, effective and long-lasting in its effects. What is clear from virtually every study of sleep treatments is that CBT may be the only treatment for sleep problems that doesn’t have side effects and negative impacts into the next day. According to a 2015 Consumer Report survey, 36% of people who took a sleeping pill felt drowsy the next day. They also report a study of 410,000 adults published in the American Journal of Public health which found that those who took sleeping pills were twice as likely to be in automobile crashes. The researchers in this study concluded that people taking sleep medications were as likely to have car accidents as people with blood-alcohol levels above the legal limit!

So what are the recommendations and interventions used in CBT for insomnia?

  1. Spend only seven or eight hours in bed, and don’t compensate for insomnia by lying in bed for ten or eleven hours, as that just teaches you to be an inefficient sleeper.
  2. Go to bed and get up at the same time every day.
  3. Don’t go to bed unless you actually feel sleepy. If you can’t fall asleep get out of bed and do something peaceful and relaxing until you are sleepy, and then go back to bed.
  4. Try to get regular exercise but don’t exercise in the evening.
  5. Use your bed only for sleeping (or sex), don’t read or watch TV or look at your smartphone in bed.
  6. Don’t nap.
  7. Reduce your intake of caffeine, nicotine, and alcohol, especially later in the day.

Now it’s time for my nap—no, my mid-day exercise!

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

Why You Shouldn’t Believe Everything You Read in the Newspapers about Medical Studies

One of my favorite journals is called PLOS ONE.  This is a journal which supports open access. That means anyone can access any article in this Journal without paying a fee. Medical studies published in this journal are accessible to anyone.

Most of you probably don’t realize but when you see a medical study quoted in a newspaper article, you can’t actually access the original study on the Internet without paying a hefty fee, usually $20-$40! If you have access to a medical library then you may be able to access the article but for most people the original articles are off-limits without paying large fees.

Plos.org is an organization that supports open access publication of scientific articles.

That’s why I admire them.

Back to my main story. A recent study in PLOS ONE looked at how often medical research results are replicated, meaning does a second or third similar study show the same results.

The researchers in this study looked at 4723 studies that were included in 306 meta-analysis articles. (A meta-analysis is a study where you combine the results of many other research studies in order to get an overview of findings.)   The researchers divided the studies into lifestyle related studies which looked at things like drinking coffee or smoking cigarettes and non-lifestyle studies such as genetic markers for Alzheimer’s. There were 639 lifestyle studies and 4084 non-lifestyle studies.

The question is of the studies that were picked up by newspapers, how many of them were replicated by subsequent studies?  The answer is only about half of the studies held up when tested again in another study. The other thing that was interesting in this article was that when studies failed to replicate, newspapers never reported that failure. Interesting examples included studies that linked a specific gene to depression, schizophrenia, or autism. None of these studies replicated successfully, which you think would be big news and would be reported by many newspapers, but the truth is that not a single newspaper article reported these failures to replicate.

This shows that newspapers don’t have much genuine interest in good science reporting. Good science reporting always involves being skeptical of new and different results, as well as following up on attempts to replicate those results.

So, what does this mean about science results reported in popular media? What it probably means is that if the finding is new and exciting and different, you probably should be highly skeptical of it being true. And the more esoteric the finding is (such as genetic markers) the more skeptical you should be.

For instance, a recent study that was funded by drug companies looked at whether the statin class of medications have side effects or whether these side effects are just a placebo effect. I’ll write more extensively about this study later, but the study’s findings–that only when people knew they were taking statins did they experience side effects– should probably be viewed very skeptically since many other studies have shown side effects from statins and many clinical reports have confirmed the side effects. (And of course any study that is funded by the manufacturer of a drug should be viewed highly skeptically.)

The bottom line is this: finding the truth is hard, and science is no shortcut. Only findings that have been repeated and replicated in numerous studies should be believed.

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.

Depression Often Misdiagnosed, and Untreated

The New York Times had an interesting article about how depression is often misdiagnosed in the US, and how most people who actually have depression don’t get treatment.  They reference a research study just published in the JAMA Internal Medicine.Depression

This research study performed by Mark Olfson, Carlos Blanco, and Steven C. Marcus, looked at responses from 46,417 people on the Patient Health Questionnaire-2 (PHQ-2) which is a brief screening tool for depression. A score of over 3 indicates depression on this scale.

What did they find? They found that approximately 8.4% of all adults studied had depression, but only 28.7% had received any depression treatment in the previous year! That means 71.3% of the people who suffer depression got no treatment for this depression.

Of those who were being treated for depression, about 30% actually had depression based on the screening, and another 22% had serious psychological distress. That means that of the people in the study who were being treated for depression roughly 48% neither suffered depression nor did they suffer serious psychological distress, indicating inaccurate diagnoses by the treating professionals.

There were some interesting correlates of depression. About eighteen percent of those in the lowest income group suffered depression, while only 3.7% of those in the highest income group suffered depression. It pays to be rich!

Depression was more common in those who were separated, divorced, widowed, or who had less than a high school education. None of this is terribly surprising.

How did depression sort out by age?

In the 18 to 34-year-old group 6.6% suffered depression. In the 35 to 49-year-old group 8.8% suffered depression. Ten percent of the 50 to 64-year-old group suffered depression. Of those over 65, only 8.3% suffered depression. So at least in this sample the 50 to 64-year-old group was slightly more likely to suffer depression, and contrary to what many people think, the youngest adults were somewhat less likely to suffer depression.

Of those who were married only 6.3% suffered depression. Of those who were separated, divorced, or widowed, 13.3% suffered depression. Divorce is bad for mental health, with almost a doubling of rates of depression.

Most of the patients who were treated for depression were treated by general practitioners (73%), with roughly 24% receiving treatment by psychiatrists and 13% receiving treatment by other mental health specialists. (There was some overlap, that’s why the numbers add up to more than 100%.)  This may explain the rather poor diagnosis and treatment of depression because general practitioners although competent and intelligent, are very busy and typically only have a few minutes to spend with each patient, not enough to do a good job diagnosing and treating depression.

CONCLUSIONS ABOUT DEPRESSION FINDINGS

What can we conclude from this research?

  1. Almost 10% of the adult population suffers from depression. Of those people who have depression less than 30% of them will get any treatment for depression.
  1. You are more likely to suffer depression if you are in the lowest income group, divorced, separated or widowed, or have no high school education. If you are married you have half the probability of being depressed.
  1. Many adults receive depression treatment even though they don’t really meet the criteria for depression. In this study, almost half of the people receiving treatment for depression were neither depressed nor were they even particularly distressed.
  1. Rates of depression by age groups were relatively equal, with the youngest age group having the least depression and the middle-aged group (50 to 64) suffering somewhat more depression. Married people are suffer half as much depression as divorced, separated, or widowed people.
  1. Most people received depression treatment from their general practitioner or internal medicine doctor, with a smaller number receiving treatment from a psychiatrist, and even a smaller number receiving treatment from psychologists. This also meant that most people who receive depression treatment were treated using medication, and very few people received psychotherapy, even though most studies comparing medication to cognitive behavioral therapy for depression have shown that therapy performs at least as well as medication and probably better over the long term, with less relapse.

Reading between the lines of this study, it suggests that many people who feel depressed would benefit from receiving an accurate diagnosis from a clinical psychologist, and might very well also benefit from receiving cognitive behavioral therapy for depression rather than medication. Even if medication is indicated, a psychologist could recommend it to the patient’s general practitioner, and then monitor more closely the results.

The study also suggests that many people receive antidepressant medication who actually are not depressed, which needlessly exposes them to side effects and also fails to provide the correct treatment for what troubles them.

And finally, since only about 30% of those who suffer depression received any treatment for it, if you feel depressed, be sure to pursue treatment for depression. Get an accurate diagnosis and then get treatment, ideally with a psychologist or therapist who practices cognitive behavioral therapy. If you want more information about depression, I’ve written extensively about it with a complete list of depression articles.

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Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.