Got insomnia? The internet may bring relief

Cognitive behavioral therapy (a method of training a person’s mind so that they think about and respond to circumstances differently) is a tried-and-true treatment for insomnia, a condition characterized by difficulty falling asleep, difficulty staying asleep, or early morning wakefulness. But not everyone can find a qualified therapist or even afford treatment. Fortunately, a new study has found that an Internet-based cognitive therapy program is an accessible and effective treatment for people searching for sleep.

Online sleep school

The study, published in the Archives of General Psychiatry, included 45 people who had experienced insomnia for at least six months, with episodes at least three times per week and daytime fatigue or impairments caused by the lack of sleep. They were randomly assigned to either participate in the Internet intervention or no treatment.

The Internet program involved three areas of training:

• behavioral, including rules to regulate the sleep-wake schedule, strengthen the association between bed and sleep, and reduce stimulation in the evening and during waking periods at night;

• educational, emphasizing sleep hygiene practices like avoiding nicotine, alcohol, and caffeine in the evening; and

• cognitive, through which unhelpful thought patterns that lead to anxiety about missed sleep are reframed.

The program was highly interactive, offering personal recommendations based on participants’ responses to questions after each training section. It also used daily e-mail reminders and prompts to keep people involved.

Better than counting sheep

After nine weeks of treatment, sleep diaries revealed that the Internet intervention group had experienced dramatic improvement in sleep, but people in the control group had not. The improvements achieved by those who went through the Internet program were maintained at a follow-up assessment six months after the end of the trial.

“These results suggest that an Internet-based cognitive behavioral training program may be useful as a first step in providing care to adults with insomnia,” said Dr. Lee Ritterband at the University of Virginia Health System in Charlottesville, Virginia. “An effective and inexpensive Internet intervention has the potential to expand the treatment options and fill the unmet needs of many people with insomnia, especially those whose geographic location limits their access to care.”

Other remedies for insomnia

In addition to participating in either a face-to-face or Internet-based cognitive behavioral therapy program, scientific evidence suggests that the following supplements might help people with insomnia:

• herbal preparations including valerian, hops, and lavender;

• melatonin, a natural hormone that regulates the human biological clock; and

• 5-HTP (5-hydroxytryptophan), a compound made in the body from L-tryptophan and converted by the body to the sleep-enhancing neurotransmitter, serotonin.

Since melatonin and 5-HTP can cause side effects or interact with certain prescription medications, they should be used only under a doctor’s supervision.

(Arch Gen Psychiatry 2009;66:692–8)

Maureen Williams, ND, received her bachelor’s degree from the University of Pennsylvania and her Doctorate of Naturopathic Medicine from Bastyr University in Seattle, WA. She has a private practice on Cortes Island in British Columbia, Canada, and has done extensive work with traditional herbal medicine in Guatemala and Honduras. Dr. Williams is a regular contributor to Healthnotes Newswire.

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