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Surprising Results That Will Change the Way I think About Insomnia Treatment

Is it just because I’m a psychiatrist that I’m so blown away by this new study?

I’ll admit this title is not the most flashy. I’m actually surprised this study is not all over the news (like psychedelics are right now), considering what a big deal this is. 

Well, I guess I know why it’s not all over the news, because it’s not a sexy new invention or groundbreaking new drug, or a…psychedelic.

Maybe it’s because it’s telling us the opposite – that the drugs that we commonly use don’t actually work as well as we thought they do.  But as a practicing physician, it’s a very important study that will shape the way I talk about sleep medications to my patients.

For context, many, many people struggle with sleep. More than 9 million people in the US are taking meds for sleep, so it’s a huge challenge for a significant chunk of the population. Even more so, sleep is exquisitely affected during the peri-menopausal period. So many of the women that I treat, and friends and family, are struggling with sleep.

This study by DH Solomon et al is important because it demonstrates the gap between the evidence that is used for demonstrating initial efficacy of a medication (randomized control trials, usually smaller numbers, for short periods of time) and the real-world utilization of those medications. For example, in studies for sleep medications, most of them are run over a period of 12 to 24 weeks. And in real world practice, many people end up taking sleep aids chronically, for several months to even years.  And there’s very little research on that, until this study.

This study, a retrospective cohort study (granted with some limitations), has many strong points about it (large sample size, better diversity of participants, etc), but especially as it incorporates a real world lens in terms of how people actually get care. In real life, patients continue to stay on meds for years, rather than just an artificially limited time during a study.

And these results are in fact negative results – that women who do take medications for sleep don’t have any improvement in their sleep over women who don’t take medications, 1 and 2 years later.

If I’m being honest, it’s a difficult study to swallow.  As a physician, I want to help my patients feel better in the moment, to offer some relief from their struggles.  But I also know that once I start my patient on a sleep medication, even though the indication is for short term only, it often becomes a very long term thing.

With this study, I will now share with my patients that there is evidence that long term, there is very little improvement in their sleep with medications, and we should really focus much more on non-medication options, including lifestyle and behavioral interventions, and CBT for insomnia.

The lack of benefit observed in the current study suggests that when physicians begin prescribing these medicines they should discuss with patients that many patients continue them long-term, and that there is scant evidence demonstrating benefit to using these medicines beyond several months.

Of course, every situation is different, and there will likely be times I do recommend sleep meds, but this study is very important to reflect on, as my patient and I make a decision together, for the short term and longer term.   

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