There is a lot to like about the possibility of a treatment for insomnia that doesn’t rely on sleeping pills or intense and expensive counseling by specialists. While this story paints a reasonably fair picture of a small test of a brief behavioral therapy for insomnia, the overall impression given to readers may have shaded toward emphasizing the positive while skipping over uncertainties, future research challenges and possible alternative approaches.
Insomnia affects many people. And we are all subjected to a relentless flood of ads for sleeping pills. News of research into relatively simple approaches that don’t rely on drugs is understandably welcome, but stories about small, preliminary trials need to be frank about the limitations.
Although this trial was a preliminary experiment, the proposed intervention is clearly defined as two office visits and two telephone calls with a nurse, so it should have been possible to estimate the cost. Since one purpose of testing this sort of brief intervention is to offer lower-cost alternatives to established behavioral treatment for insomnia, readers should have been given some estimate of the relative costs of the interventions.
The story tells readers that 55 percent of people in the active intervention group no longer met the criteria for insomnia after four weeks. However, readers are not told how the researchers defined insomnia. Was it a complete inability to sleep? How frequently did the participants have trouble sleeping? How much more did they sleep after treatment? Without these and other details, it is difficult to get a feel for what effect the treatment had.
While this story reported how many people needed to be treated in order to make a difference for at least one… a statistic we encourage journalists to use more… the story reported twice as many people benefited as the researchers actually said they saw. The researchers wrote that one person either had remission (no more insomnia) or response (significantly less insomnia) for every 2.4 people treated. But the story says that for every 2.4 participants treated one responded and one overcame insomnia.
We won’t hold this story to this criterion because neither the journal article on the test nor an accompanying commentary noted any adverse events. However, the story could have pointed out that a trial this small generally would miss all but the most common problems. Also, the story could have pointed out that until further evidence is developed, it is not know for certain how this type of intervention compares with alternatives. If it turns out that for some people this treatment is less effective than alternatives, then prescribing it would mean leaving them at greater risk of being harmed by insomnia.
The story gives a brief description of the experiment and some of the main outcomes that the researchers measured. The story would have been better if it told readers more about the limitations of this small trial, including what sort of further testing would be needed to determine if the intervention would work for people in the general population, rather than just those who match the profiles of the individuals who volunteered to participate in this test. The story compared this brief intervention to more established behavioral therapy, without noting the pitfalls of trying to compare results from different trials. The story did not tell readers that there is ongoing debate about the best way to measure the results of insomnia studies.
The story provides estimates of how many people complain of insomnia. It also portrays this intervention as an alternative to existing treatments, rather than an effort to expand treatment to more people.
The story includes comments from the author of a commentary article that appeared in the Archives of Internal Medicine along with the research article. In the disclosure section of their article, some of the researchers reported ties to pharmaceutical companies, but since this trial tested a non-drug approach and was funded by public agency and academic grants, it seems reasonable to consider the industry links as not being relevant to this study.
We will credit this story for discussing the alternatives of sleeping pills and cognitive behavioral therapy. Although there was no reference to other less-intense non-drug approaches that clinicians may recommend for dealing with insomnia, there was a comment at the end of the story that offered some basic advice that readers could use on their own.
The story says this form of “brief behavioral treatment for insomnia is not yet generally available”. It also described this study as being a first step in the process of making such an intervention available without making predictions about a timetable.
This story suggests that there are no brief behavioral interventions available to people with insomnia. They story should not have suggested that the only alternative treatments are drugs and expensive cognitive behavioral therapy.
The story does not appear to rely on a news release.