Millions of people worldwide suffer from chronic insomnia – defined as the difficulty of falling and staying asleep no less than three nights a week for at least a month – and almost as many take prescription medications to reduce symptoms.
Taking these drugs, however, is not without its dangers – countless insomniacs report becoming psychologically dependent on their artificial sleeping aides and experiencing a variety of unwanted side-effects, such as daytime drowsiness, nausea and muscle aches.
Fortunately, the current industry standard for maintaining therapeutic benefits is not set in stone – a new study, recently published in the journal Sleep Medicine, has challenged the usual approach by demonstrating that smaller and fewer doses of sleeping pills, as well as the use of placebos, could provide the same benefits at a lower cost.
In the study, researchers from the Perelman School of Medicine at the University of Pennsylvania treated 74 adults experiencing insomnia with 10 mg of the sleeping pill zolpidem (Ambien) for four weeks. Those who responded to the treatment were then assigned to three dosing groups for 12 weeks: nightly dosing with 10 mg or 5 mg, “intermittent dosing” with 10 mg 3 to 5 days a week, or “partial reinforcement” through nightly pills in which half were 10 mg capsules and half were placebo capsules.
All three strategies were effective in maintaining the ability of the study subjects to fall and stay asleep, but those in the second group slept worse and reported more – and more severe – symptoms than those in the other two groups. This suggests that the commonplace practice of taking sleeping pills only some days of the week is not the most efficient one.
Another finding of the study was that the usual approach of “starting low and going slow” works worse than starting high and then going low – it is much better to take 10 mg nightly until the desired effect is reached, and then either decrease the nightly dosage or go with intermittent dosing, taking placebos on non-medication nights.
The authors see their findings as a path diverting from the tendency to increase dose over time, as well as making the use of sleep medications safer and more cost effective both for consumers and pharmaceutical companies (as consumers take a higher percentage of placebos, the profit margin would be higher on placebos than it is on the drug).
“What is particularly novel about the present study is the use of placebos on non-medication nights and that such a practice appears to extend a level of therapeutic benefit that is not seen with intermittent dosing,” said Michael Perlis, PhD, an associate professor in Penn’s Department of Psychiatry and Director of the Penn Behavioral Sleep Medicine Program.
If further research supports the possibility of such conditioning, this may influence how medications are prescribed for maintenance therapy in the future, with the prescriber indicating not only what medication and what dose to take, but also what schedule of medication and placebo is needed to maintain therapeutic effect.
Disclaimer: this article is not a medical advice, please contact a medical professional if you need help.