Chronic Insomnia Treatment with Half-And-Half Placebo Replacement

The science of sleep medicine has long proved difficult in the treatment of chronic insomnia, with researchers still not convinced of the effectiveness of sleeping pills currently on the market. However, researchers at Penn University in the US have 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.
“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 the study’s senior author Michael Perlis, PhD, an associate professor in Penn’s department of Psychiatry and director of the Penn Behavioral Sleep Medicine Program. “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 standard used in the US and Australia 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.