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本帖最后由 大洋彼岸之风 于 2009-6-3 10:52 编辑
Study: Web Therapy Can Help Ease Insomnia
Getting a decent night's sleep shouldn't be such a crapshoot. But for the 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 prescriptionsin 2008 for sleeping pills like Ambien and spent more than $600 millionon over-the-counter sleep-inducing supplements such as melatonin andvalerian
root. Others seek medical treatment or psychological therapyto get to sleep, while the rest of us accept our nocturnal tossing andturning as just another of life's unavoidable nuisances and gulp anextra 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 theday — and researchers continue to search for its causes and cure. Now anew study in the journal Sleep suggests a surprising treatmentfor the sleepless: the Internet. Web-based treatments have emerged forall 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, onlinetherapies are typically simpler and less expensive. Major healthinsurers like Blue Cross and Aetna even offer Web-based anti-insomniaprograms 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 Internetprogram, like the feeling that you are really in the driver's seat,"says the study's author, clinical psychologist Norah Vincent, who addsthat many of the 40 participants who completed her multimedia programreported both better sleep quality and less daytime fatigue than did acontrol group. "People like to have autonomy in solving problems.
Ithink it motivates them more," she says.(Read "Online Helpdesk.")
Based on cognitive-behavioral-therapy techniques, Vincent's virtualtherapy combines videos, text and audio clips to teach the sleeplesseverything about good sleep hygiene, from how to relax the body beforegetting into bed to how not to stress out when you fail to doze offright away. (One of the worst things you can do when you can't fallasleep is lie there and dwell on the consequences of not getting enoughsleep.) Participants in her study were asked to keep digital sleepdiaries and practice the techniques that were demonstrated onscreen.They were also allowed to download audio clips of a sleep therapist andan actor in a staged one-on-one session and listen to them on theiriPods. (See pictures of the iPhone.)
While prior studies have shown that online therapy can helpalleviate insomnia, little research has compared it directly with otherapproaches. Vincent's study, on the other hand , found that 35% of thosewho received online treatment reported that they were "much" or "verymuch" improved, compared with 50% of those who received in-person grouptherapy using the same behavioral-cognitive approach at Vincent's sleepclinic at the University of Manitoba in Canada.
The benefit of theonline strategy, of course, is that it can work for people who don'thave access to face-to-face therapy.
Some proponents of online therapy say it may actually be moreeffective than in-person counseling. "You don't have to worry aboutpersonalities, and you can go over the material over and over," notesGregg Jacobs, an insomnia specialist at the University of MassachusettsMedical School, who has offered a self-guided online program for thepast two years. Since patients don't have to make time for in-officeappointments and can proceed at their own pace, Web-based programs havethe potential to reach a much broader audience.
ut computer counseling has its detractors,
particularly when itfails to get at the root of patients' sleep issues. "There is only sofar you can go with it," notes Dr. S.K. Mostafavi, who runs theAdvanced Sleep Medicine Services chain of sleep clinics in SouthernCalifornia and has served as a sleep "guru" for the popular weight-lossreality show The Biggest Loser. Online therapy can be helpfulas an educational tool, says Mostafavi, but he cautions, "You don'thave the benefit of talking to a professional and finding out what iscausing the insomnia.":call: (Insomnia may be a side effectof an underlying condition, such as anxiety, Alzheimer's, arthritis orasthma, or it can result simply from poor sleep habits, like failing tokeep a regular bedtime.) Vincent concedes that patients who have deeperproblems — those who are depressed or suicidal — or have troubleconcentrating are unlikely to benefit from the program.:shutup:
As digital therapy evolves, "one of the tricks is to identify whowill respond best to online treatment," notes Dr. Michael Sateia,director of sleep medicine at Dartmouth-Hitchcock PsychiatricAssociates in Lebanon, N.H. "Sleep medicine is still in its childhood,and for decades we have lived in a culture where pharmacologicaltherapies have been the mainstay. But we are beginning to change thatmentality." Sateia's center, for example, recently hired a nursepractitioner to offer more affordable group therapy as an alternativeto individual counseling by a psychiatrist. (Read: "On the Couch Online: Does Tele-Therapy Work?"
One area that has been studied extensively is the benefits ofcognitive-behavioral therapy vs. those of medication. A recent study inthe Journal of the American Medical Association found thatwhile cognitive therapy alone or in combination with medication workedequally well to treat insomnia in the short term, patients fared better over the long term with talk therapy alone.:sleepy: "Cognitive therapy shouldbe a first-line approach," says 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 treatsleep problems, online programs are "a very innovative andcost-effective way of looking at insomnia therapy," says Morin. Theremay be no single cure-all for sleeplessness, but such promisingalternatives should help more night owls ;P:$wake in the morning feelingrefreshed. |
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