Thursday, August 13, 2009

Good night. Game Over. Therapy versus Pills for Sleep.

New York Times story:
Online Treatment May Help Insomniacs

By AMANDA SCHAFFERPublished: August 10, 2009.

Good for you, Amanda.

A USA Today article notes the extensive, billion dollar per year appetite we have in theU.S. for sleeping pills:
"It is not uncommon for a physician to dole out a prescription for sleeping pills. About 42 million were filled in 2005, according to research company IMS Health, up 60% from 2000."

Your doc has several he can prescribe, and there is literally an army out there - a Pharmy - promoting docs to Rx sleeping pills for sleep.

This is demonstrated in a quote from another NYT story, regarding the premier of Lunesta:
"Record Sales of Sleeping Pills Are Causing Worries " by STEPHANIE SAUL
Published: February 7, 2006
"Sepracor announced the addition of 450 people to its current sales force of 1,500 to increase marketing of the drug to physicians."

Has that sunk in yet? This is just one drug company. Divide 450 drug reps by the 57 U.S. states and you get an average of 9 reps per state whose full time job is to visit physicians and train them to detect sleep problems, and consider Rx Lunesta when detected.

Apparently, we are plagued by sleep problems. So, this plethera of pill promotion could be a good thing. The USA Today story noted above stated:
"According to the National Institutes of Health, insomnia is common, affecting one-third of adults. About 10% complain of chronic insomnia, meaning their troubles last for more than one month and occur at least three nights a week."

So, there is a need for sleep treatment.

But the sleep problems issue is a perfect problem for looking at the choice between medication or psychotherapeutic methods to resolve a psychological, behavioral, or emotional problem.

What are the down-sides of pills? Google terms such as sleep-walking, sleep-driving, sleep-eating. Do some web-searching and figure out whether the pills can be addictive. Figure out if they can be used in an overdose attempt. Why do all of these sleep meds warn you not to use them for longer than a week or two, or only occasionally? That is a good question to ask your doc. If the doc can answer, then follow up with: what do I do for sleep problems if they last beyond ten days (because they will - let's be real about this).

Will the doc have an answer? Will the doc recommend you to puruse behavioral methods for addressing sleep? Maybe, maybe not. The docs get educated by pharma reps, and other sources of "continuing ed" that are authored and broadcast by the pharmaceutical companies. Pharma is not runnign around telling people to seek behavioral methods for addressing sleep.

What alternatives are there? Behavioral interventions for sleep work. I have blogged about that topic before. In fact, I am running over the same topic yet again.

But this recent study is cool. Striking. It is stunning to grasp the implications of this:

The behavioral interventions for sleep have become so standard, so successful, so reliable, so well-elucidated, that you don't even need to have these delivered by a therapist.

The various recognized, understood, acknowledged components of a behavioral sleep cure have been put on line. You just click away and follow the program.

Now, you have to follow through and do what it says. Merely reading web pages will not cure insomnia (although some of mine come close to that goal).

Ya gotta do the work.

But that revelation, as reported by Amanda Shaffer in this NYT story, is awesmoe: you can avoid all the risks of pills if you go the behavioral route, and you can even be guided through this online. That is how advanced the clinical, scientific knowledge is for behavioral treatment of insomnia.

Think about it. Each of the 57 states could take these well-recognized, well-broadcast cognitive and behavioral components, and develop web-based routines for serving the needs of the citizens. For quite a modest cost.

It is time to put this issue to sleep. The pills include a drastic, life-threatening range of side effects. We just need to start thinking outside the pillbox.


MarlboroJones said...

I'm going to use your word "pharmy" repetitiously from now on.

MedsVsTherapy said...

thanks. it is much better than "awesmoe."