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Study: Web Therapy Can Help Cure Insomnia

Getting a decent night's sleep shouldn't be such a crapshoot. But for an estimated 30% of American adults who suffer from at least occasional insomnia, nightfall is no guarantee of slumber.
To combat wakefulness, Americans filled more than 50 million prescriptions in 2008 for sleeping pills like Ambien, and spent more than $600 million on over-the-counter sleep-inducing supplements such as melatonin and valerian root. Others seek medical treatment or psychological therapy to get to sleep, while the rest of us accept our nocturnal tossing and turning as just another of life's unavoidable nuisances, and gulp an extra cup of coffee the next morning to compensate. (See the Year in Health, from A to Z.)

But despite our best efforts, about 10% of Americans still suffer from persistent insomnia (defined as difficulty initiating or maintaining sleep) — namely falling asleep or being functionally impaired by sleepiness during the day — and researchers continue to search for its causes and cure. Now a new study in the journal Sleep suggests a surprising treatment for the sleepless: the Internet. Web-based treatments have emerged for all kinds of bad habits and disorders, such as overeating, smoking, depression — and insomnia. (Read "Can a Sleep Disorder Predict Parkinson's?")

Compared with face-to-face counseling or medical treatments, online therapies are typically simpler and less expensive. Major health insurers like Blue Cross and Aetna even offer Web-based anti-insomnia programs for free (you can check out the retail versions at cbtforinsomnia.com or myselfhelp.com for as little as $20). And there's growing evidence that online therapy really works: in the new Sleep study, 81% of participants who completed a five-week, online program for insomnia reported improvement in sleep.

“There may be some unique things that you get from an Internet program, like the feeling that you are really in the driver's seat," says the study's author, Norah Vincent, a clinical psychologist, who adds that many of the 40 participants who completed her multimedia program reported both better sleep quality and less daytime fatigue than a control group. "People like to have autonomy in solving problems. I think it motivates them more," she says. (Read "Online Helpdesk.")

Based on cognitive behavioral therapy techniques, Vincent's virtual therapy combines videos, text and audio clips to teach the sleepless everything about good sleep hygiene, from how to relax the body before getting into bed to how not to stress out when you fail to doze off right away. (One of the worst things you can do when you can't fall asleep is to lie there and dwell on the consequences of not getting enough sleep.) Participants were asked to keep digital sleep diaries and complete practice the techniques that were demonstrated onscreen. They were also allowed to download audio clips of a sleep therapist and an actor in a staged, one-on-one session and listen to them on their iPods.

While prior studies have shown that online therapy can help alleviate insomnia, little research has compared it directly with other approaches. Vincent's study, on the other hand, found that 35% of those who received online treatment reported that they were "much" or "very much" improved compared with 50% of those who received in-person group therapy using the same behavioral cognitive approach at Vincent's sleep clinic at the University of Manitoba in Canada. The benefit of the online strategy, of course, is that it can work for people who don't have access to face-to-face therapy.

Some proponents of online therapy say it may actually be more effective than in-person counseling. "You don't have to worry about personalities, and you can go over the material over and over," notes Gregg Jacobs, an insomnia specialist at the University of Massachusetts Medical School, who has offered a self-guided, online program for the past two years. Since patients don't have to make time for in-office appointments and can proceed at their own pace, Web-based programs have the potential to reach a much broader audience.

But computer counseling has its detractors, particularly when it fails to get at the root of patients' sleep issues. "There is only so far you can go with it," notes Dr. S.K. Mostafavi, who runs the Advanced Sleep Medicine Services chain of sleep clinics in Southern California and has served as a sleep "guru" for the popular weight-loss reality show The Biggest Loser. Online therapy can be helpful as an educational tool, says Mostafavi, but cautions, "you don't have the benefit of talking to a professional and finding out what is causing the insomnia." (Insomnia may be a side effect of an underlying condition, such as anxiety, Alzheimer's, arthritis or asthma, or it can result simply from poor sleep habits, like failing to keep a regular bedtime.) Vincent concedes that patients who have deeper problems — those who are depressed or suicidal — or have trouble concentrating are unlikely to benefit from the program.

As digital therapy evolves, "one of the tricks is to identify who will respond best to online treatment," notes Dr. Michael Sateia, director of sleep medicine at Dartmouth-Hitchcock Psychiatric Associates in Lebanon, N.H. "Sleep medicine is still in its childhood, and for decades we have lived in a culture where pharmacological therapies have been the mainstay. But we are beginning to change that mentality." Sateia's center, for example, recently hired a nurse practitioner to offer more affordable group therapy as an alternative to individual counseling by a psychiatrist.

One area that has been studied extensively is the benefits of cognitive behavioral therapy compared with those of medication. A recent study in the Journal of the American Medical Association found that while cognitive therapy alone or a combination of cognitive therapy and medication worked equally well to treat insomnia in the short term, patients fared better over the long term with talk therapy alone. "Cognitive therapy should be a first line approach," notes the study's lead author, Charles Morin, "but many people do not have access to it."

With demand far outstripping supply for therapists trained to treat sleep problems, online programs are "a very innovative and cost-effective way of looking at insomnia therapy," says Morin. There may be no single cure-all for sleeplessness, but such promising alternatives should help more night owls wake in the morning feeling refreshed.

(See the top 10 medical breakthroughs of 2008.)

Read "In Search of Sleep."

Vocabulary
1. DECENT(adj.) []
a. 正派的;合乎禮儀的Ex: I only associate with good decent fellows. (我只和正派的好人交往。); DECENT CULTURAL BACKGROUND; DECENT-PAYING JOB; half-decent political commentator of 半吊子政論家
b. 體面的;像樣的;還不錯的Ex: For a week he didn't have a decent meal. (他一個星期沒有吃一頓像樣的飯。)
c. 親切的;寬容的;樂於助人的Ex: The new manager is pretty decent to us. (新上任的經理對我們相當和氣。)
2. A CRAPSHOOT(ER)
3. NIGHTFALL (n.) 黃昏
4. SLUMBER (v.) 睡眠打發; 微睡; 淺眠
5. AMBIEN
6. OVER-THE-COUNTER MEDICINE 成藥
counter指的是店面裡(在這裡指藥局)的櫃檯,有些要你只需要去藥房買,在櫃檯上交易就可購得,所以叫做"over-the-counter"
7. SLEEP-INDUCING (勸誘) SUPPLEMENT(S) (補給物) 安眠藥
8. MELATONIN 退黑激素(Melatonin)有人叫聚黑激素，它是腦部「松果體」所分泌的一種激素，在１９５８年首先從牛的松果體抽淬物中所分離出來的物質; 葡萄王的夜安靈就是這個成分，用來安眠。
9. VALERIAN ROOT自纈草根莖採製的鎮定劑
10. NOCTURNAL TOSSING AND TURNING 徹夜輾轉難眠
11. NUISANCE(S)
a. 討厭的人(或事物);麻煩事, Ex: He was nothing but a nuisance and a rascal. (他是一個十足的討厭鬼和惡棍。)
b.【律】妨害行為,騷擾行為, Ex: The prosecutor indicated him of nuisance. (檢察官以妨害行為起訴他。)
12. HULP AN EXTRA CUP OF COFFEE
13. IMPAIR
a. 削弱;減少 Fatigue impaired their judgement.(疲勞削弱了他們的判斷力。)
b. 損害,損傷 Poor food impaired her health. (粗劣的食物損害了她的健康。)
14. FACE-TO-FACE COUNSELING
15. MEDICAL TREATMENTS
16. HEALTH INSURER (n.) 保險業者
17. VIRTUAL (adj.)
a. 事實上的,實際上的,實質上的 He is in a state of virtual slavery.(他實際上處於一種被奴役的狀態。)
b.【電腦】虛擬的 Virtual community 虛擬社區
18. GOOD SLEEP HYGIENE 衛生 The grave problems of public hygiene are connected with insufficient sewage system of the city. 公共衛生方面的嚴重問題與該城低效率的污水處理系統有關。)
19. DOZE OFF打瞌睡
20. DETRACTOR(S) 誹謗者,貶低者
21. ALZHEIMER’S DISEASE = DEMENTIA
22. ARTHRITIS
23. ASTHMA
24. CONCEDE 承認
25. PHARMACOLOGICAL 藥理學的;藥物學的
26. MAINSTAY唯一的依靠;支柱
27. A PSYCHIATRIST 精神病醫師;精神病學家
28. MEDICATION 藥物治療
29. OUTSTRIPPING SUPPLY超過,勝過 OUTSTRIP (vt.), Ex: His newspaper outstripped its rivals in circulation. (他的報紙在發行量上超過了他的對手。)
30. NIGHT OWL(S)
31. FEELING REFRESHED 補充且煥然一新
32. proponent(s) = advocator

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