Using sleeping pills to treat insomnia is not an ideal solution, with research showing that the meds may simply postpone sleepless nights for a short duration and create further sleeping difficulties further down the track. But try telling that to the 9 million or so Americans who are dependent on sleeping medication to help them get a good night's rest.
Fortunately, new research conducted by Penn University in the US has found that a half-and-half mixture of sleeping pills and placebo tablets might be just as effective as a nightly schedule of sleep medication for treating chronic insomnia. In contrast with the country's standard prescribing practices for the sleep disorder, the researchers contend that the use of smaller and fewer doses of sleeping pills, along with a mix of placebos in the regimen, could deliver both medical and cost benefits.
"The clinical effects of sleeping pills cannot be relied on to last forever, and long-term use increases risk of psychological dependence and side effects including daytime drowsiness, nausea, and muscle pain," said Michael Perlis, senior author of the study, in a press release. "Our research found that changing the industry standard for maintenance therapy can maintain treatment responses and lower the incidence of side effects."
The researchers treated 74 adults experiencing chronic insomnia – patients experiencing difficulty falling or staying asleep for a minimum of three nights per week for at least one month. The participants were randomly placed in three different dosing groups: nightly dosing with 10 mg or 5 mg of the sleeping pill zolpidem (Ambien); intermittent dosing of 10 mg three to five times per week; or partial reinforcement, via nightly pills, half being 10 mg capsules and the other half placebo capsules.
The results, published in Sleep Medicine, showed that patients in all groups were able to achieve and maintain sleep, but those receiving intermittent dosing – the current US standard for treating chronic insomnia – experienced worse sleep and more severe symptoms than the other groups. This suggests that the partial use of placebos could confer more medical benefits than intermittent dosing, while potentially providing as much sleep maintenance as nightly medicated dosing.
"When it comes to day-to-day quality of therapeutic outcomes, the strategy we use most frequently, the intermittent doing strategy, performed worst," Perlis said. "Our findings also go against the standard practice of 'start low and go slow,' in favour of a 'start high and go low' dosing strategy, in which a patient starts with 10 mg nightly and then when the desired result is reached, switch to either a lower nightly dose or intermittent dosing with placebos on non-medication nights."
The researchers acknowledge that their findings should only be considered a preliminary study, but say that the results offer promising directions for further research. Their findings suggest that reinforcement strategies involving less overall medication – through the use of both placebos and lower dosing for maintenance – could be a viable means of treating patients with chronic insomnia in the future.
"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 Perlis.
"This effect is thought to occur owing not only to the enhancement of patient expectancy but to the conditioning of medication effects, ie. the medication induced effects may be elicited, with conditioning, by the medication capsule itself, and that this can be sustained over time with occasional use of full dose medication (partial reinforcement)."