This story describes the step-by-step path of an individual patient/author seeking information to compare drugs to cognitive behavioral therapy (CBT) in treating his own insomnia. It isn’t a news story about research, although it draws from a recent Annals of Internal Medicine study and other studies. The writer mixes his own personal experience with a thorough discussion of the data. The result is a very helpful and readable overview of the evidence on insomnia treatments.
Insomnia is very common complaint to primary care physicians. Many patients specifically request a sleeping pill, believing them to be more effective than non-pharmacologic approaches. This story provides value by emphasizing the effectiveness of these non-drug approaches.
We wish this story comparing effectiveness of different therapies for insomnia had compared costs as well. How often is cognitive behavioral therapy for insomnia covered by insurance? Is there a co-pay per visit? What is a typical number of treatments, and what might it cost? How does that compare to taking some of the common drugs?
The story carefully lists several benefits from the Annals study: patients treated with CBT fell asleep almost 20 minutes faster and were awake in the night almost half an hour less and their total time “sleeping in bed” was increased by 10 percent.
We have only two minor quibbles. One is that the writer compares himself to the study participants, and he may not meet the same criteria as they did. “For me, and many patients, C.B.T. works. And as studies show, it works better than drugs,” he wrote. But the Annals study had “narrow inclusion criteria” that perhaps deserved some comment.
The second is that total sleep time gain is described in relative terms with a figure of 10%. The absolute increase in sleep time was 7 minutes, according to the study.
There is no known harm to CBT for insomnia. There are myriad harms to commonly used sleeping medications. Although the story would have been strengthened by explaining those harms (further dissuading people from medication, which is what physicians recommend), the story’s failure to mention harms of medications when the article itself was about CBT seems overly punitive. We’ll rate it Not Applicable.
The writer-as-patient tells us that “Data, not pills, was my path to relief.” He provides high-quality evidence to support his path to his own personal relief. He doesn’t quote others or balance his own interpretation with the comments of experts, which might have made the story stronger.
There is no exaggeration of the impact of insomnia.
While the story is a personal one, we think it could have been strengthened with the opinion of a primary care provider who commonly treats insomnia. Any story that makes health claims should have their facts/interpretation run by an expert.
The story does a good job of explaining the alternatives of CBT, or behavioral vs. drug therapy for insomnia. It might have been interesting to compare “no treatment” at all to the others.
We are not given a lot of detail, but consider both CBT and medications to be widely available. This is particularly true because the writer makes it clear that an online program was helpful (rather than requiring a specialized clinic or provider).
The story carefully gives us context for the research described, which is not novel.
The story does not rely on a news release.