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Thorough WSJ report on insomnia treatments would have benefited from cost comparison

Can’t Get to Sleep? Lay Off the Drugs

Our Review Summary

insomnia sleepingThis story explains why those suffering from insomnia should take heed of the American College of Physicians’ recommendation to use cognitive behavioral therapy as a first-line treatment, before turning to prescription or over-the-counter drugs.

Rather than focusing on the benefits of cognitive behavioral therapy, as a New York Times story we reviewed earlier this year did, the Wall Street Journal story lays out the serious side effects associated with insomnia drugs, providing a clear and easily understood discussion of why drug treatment should be considered a last resort, to be used only by those for whom cognitive behavioral therapy has failed.

However, the story would have been stronger if it had discussed the costs of treatments, and provided more specific numbers on how beneficial these treatment options are in clinical research.


Why This Matters

Lack of sleep is a big concern for many Americans, especially older adults. This story specifically addressed why sleep medications are not ideal for this age group, in terms of potential harms. But it didn’t dig deep enough into the data on the effectiveness of the various options. This helps readers assess the all-important question: Do the benefits outweigh the harms? And, without cost information, readers can’t answer another important question: Can I afford it?


Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Unfortunately, like the earlier Times story, the WSJ story doesn’t mention costs, either those associated with taking prescription or over-the-counter drugs to treat insomnia or those associated with cognitive behavioral therapy. The closest the story comes to mentioning cost is when it notes that one problem with the use of prescription sleep aids is that insurance may not cover long-term use; this would have been an obvious point at which to note how expensive these drugs can be. The story suggests that cognitive behavioral therapy can be effective after as few as two sessions, but it doesn’t say how many sessions the average patient requires, how expensive those sessions are likely to be nor how likely it is that insurance would cover this type of therapy.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story notes that one study of cognitive behavioral therapy showed that it reduced chronic insomnia and helped patients function more effectively during the daytime for up to two years. However, it does not specify whether the relief from chronic insomnia meant that patients had no bouts of insomnia or simply had less prolonged instances of insomnia, nor does it quantify how much improvement patients experienced in daytime functioning. In its discussion of chemical sleep aids, the article provides no specifics about effectiveness; rather, it focuses on the mechanisms by which the prescription drugs encourage sleep.

(For an example of how to provide more specifics, see this criterion in our review of the Times’ story on this same data.)

Does the story adequately explain/quantify the harms of the intervention?


The article focuses on why many doctors now recommend cognitive behavioral therapy rather than drugs as the first-line treatment for insomnia. As such, it does an excellent job of laying out all the negative potential side effects of anti-insomnia drugs, both prescription and over-the-counter. Given the seriousness of these potential harms – including fatigue, sleep-walking and -eating, impaired balance and increased risks of falls and motor vehicle accidents and possibly even dementia – this careful discussion of harms provides a valuable public service. Cognitive behavioral therapy does not appear to cause any harm, a point the story might have made more clearly, especially given that it describes the benefits as lasting for “up to two years,” which could lead some readers to assume that CBT stops working after a relatively short time. Nonetheless, overall, the article is more than adequate in its discussion of the harms of the two approaches.

Does the story seem to grasp the quality of the evidence?


This story is not focused on one specific study, but it notes that the American College of Physicians reviewed 15 years’ worth of scientific evidence before issuing guidelines recommending that drugs should be used to treat insomnia only if cognitive behavioral therapy has failed. More could have been said about how thorough the review was that contributed to the guidelines, and if there were any notable gaps in research that limit the findings.

Does the story commit disease-mongering?


The story does not exaggerate either the frequency or the severity of insomnia.

Does the story use independent sources and identify conflicts of interest?


The story had several independent sources and we detected no conflicts of interest.

Does the story compare the new approach with existing alternatives?


The primary focus of this story is explaining why cognitive behavioral therapy is the better alternative for treating insomnia due to the negative side effects of insomnia drugs. The story also includes a great deal of practical information about “sleep hygiene,” as well.

Does the story establish the availability of the treatment/test/product/procedure?


The story notes that CBT can be provided by any trained therapist or nurse. The story could have been more helpful if it had specified how common this training is and how a patient seeking CBT could go about finding a health care professional trained in the technique. The article also might have mentioned that systematic analysis of studies has shown that even web-based versions of cognitive behavioral therapy can effectively treat insomnia, making it even more widely available.

Does the story establish the true novelty of the approach?


The story does not suggest that cognitive behavioral therapy is new. It does, however, refer to the relatively new (as of May 2016) American College of Physicians guidelines recommending cognitive behavioral therapy over drug treatment for insomnia.

Does the story appear to rely solely or largely on a news release?


The story does not appear to rely on a news release.

Total Score: 8 of 10 Satisfactory


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