“Before I go through CBT, will I have to give up my sleeping pills? I’d like to get off them eventually, but every time I think of doing it I freak out.”
Some sleep therapists ask people with insomnia to refrain from using sleeping pills while undergoing CBT, a treatment that promotes sleep-friendly practices and a positive mindset. But this rule may be hard to comply with for people who’ve used sleeping pills for months and years. So hard, in fact, that it may discourage them from trying CBT at all.
Recently I looked into research on insomnia sufferers going through CBT while at the same time tapering off (or reducing reliance on) sleeping pills. What I found was encouraging, so I’ll share it here.
Sleeping Pills? I Love Them!
My aim isn’t to convince people comfortable with their sleep meds to come off them. I use hypnotics occasionally myself, and frankly I get tired of people demonizing them as if they were on par with heroin or crack cocaine.
But some nightly users complain, even when taking sleeping pills, that their sleep isn’t very satisfying. This perception is probably related to the fact that many sleep meds, especially when taken over time, tend to change the nature of sleep. Also, studies linking long-term use of sleeping pills to increasing vulnerability to colds, depression and mortality are not reassuring. It’s easy to see why some long-term users are interested in a path to sleep that feels more “natural.”
Tapering Off Sleep Meds
If you’ve used hypnotics for a long time, it’s not a good idea to go cold turkey, say Lynda Bélanger and colleagues in a paper on hypnotic discontinuation. Stopping abruptly puts you at greater risk for withdrawal symptoms and health complications. Hypnotic drugs should be discontinued gradually, they say–ideally with guidance from a trusted physician.
No guidelines exist showing what the optimal rate of tapering is. Your doctor might propose decreasing the initial dose by 25 percent every week or every other week. But, say these Canadian researchers, the pace of the tapering “may need to be adjusted according to the presence of withdrawal symptoms and anticipatory anxiety; it can also be slowed if the person finds it too difficult to cope or feels unable to meet the reduction goal.”
CBT Assists Tapering and Improves Sleep
In most studies of sleeping pill users undergoing CBT for insomnia, CBT has helped wean them off drugs (or reduce the amount they use) and improved their sleep. Here’s a snapshot of the results:
- CMAJ, 2003: About 77 percent of those undergoing CBT while on a drug tapering program came off their meds, vs. 38 percent on the drug tapering program only.
- American Journal of Psychiatry, 2004: About 85 percent of those undergoing CBT while on a drug tapering program came off their meds, vs. 48 percent on the drug tapering program only. CBT groups also reported greater sleep benefits than the group doing the taper alone.
- BMC Psychiatry, 2008: Added to a drug tapering program, CBT improved sleep quality in hypnotic users even more than it did in people who didn’t use drugs.
- Sleep Medicine, 2014: In this novel study, adding hypnotic medication to traditional CBT improved subjects’ sleep faster than CBT alone. (By the end of therapy, the sleep of both groups had improved equally).
So if you’d like to try CBT but are anxious about stopping your sleep meds, shop around for a sleep specialist who’s willing to work with you to tailor a program suited to your needs. What’s not to like about the prospect of improving your sleep and at the same time reducing your dependence on drugs?
What concerns do you have about CBT and sleeping pills?