Teaching those with chronic insomnia how to fall asleep produces better results than continued use of sleep medications, according to a Canadian study in JAMA.

For the study of 160 adults diagnosed with chronic insomnia, researchers at Laval University in Quebec, compared cognitive behavioral therapy (also called "talk therapy") with the sleeping aid zolpidem.

Zolpidem is sold under the brand name Ambien but is not approved for use in Canada. Similar medications used in Canada include Imovane and Restoril.

The study authors found that both weekly group therapy sessions on "sleep hygiene" and nightly medication worked equally well for those with acute, short-term insomnia. Both helped about 60 per cent of the patients get to sleep more quickly and sleep longer, researcher Charles Morin wrote.

But for those whose insomnia was more long-term, using talk therapy alone was more effective than combining it with the medication.

The combined therapy produced a higher remission rate during the six-month extended phase and the six-month follow-up period, the researchers report.

Even during the six-month follow-up, it was more effective for patients to take refresher talk therapy sessions if they found their insomnia returned. Those patients fared better than those offered drugs to take as needed, the researchers report.

"The best long-term outcome was obtained with patients treated with combined therapy initially, followed by (talk therapy) alone," Morin wrote.

Cognitive behavioral therapy and medications such as Ambien, Imovane and Restoril, are the only two treatments that have good evidence supporting their use in managing insomnia.

"Although the present findings are promising, there is currently no treatment that works for every patient with insomnia," Morin added.

Zolpidem is recommended only for short periods. Side effects include morning drowsiness and hallucinations if sleep does not arrive right away, and drug dependence is not uncommon.

There have also been reports of sleepwalking, sleep driving, binge eating and talking while sleeping on the drug.

During talk therapy, patients with insomnia are instructed on the key components of good "sleep hygiene." They include:

  • going to bed only when sleepy at night
  • using the bed and bedroom only for sleep and sex ( no reading, TV watching, or worrying)
  • getting out of bed and going in another room whenever unable to fall asleep and then returning to bed only when sleepy again
  • waking at the same time every morning.