"One weekend afternoon a couple of years ago while turning a page of the book I was reading to my daughters I fell asleep. Thats when I knew it was time to do something about my insomnia. Data not pills was my path to relief. Insomnia is common. About  percent http of adults report some symptoms of it though less than half that figure have all symptoms. Not all insomniacs are severely debilitated zombies. Consistent sleeplessness that causes some daytime problems is all it takes to be considered an insomniac. Most function quite well and the vast majority go untreated http I was one of the highfunctioning insomniacs. In fact part of my problem was that I relished the extra time awake to work. My rsum is full of accomplishments I owe in part to my insomnia. But it took a toll on my mood as well as my ability to make it through a childrens book. Insomnia is worth curing. Though causality is hard to assess chronic insomnia is associated with greater risk of anxiety http depression http hypertension http diabetes http accidents http and pain http Not surprisingly and my own experience notwithstanding it is also associated with lower productivity http at work. Patients who are successfully treated experience improved mood and they feel healthier function better and have fewer symptoms of depression http Which remedy would be best for me Lunesta Ambien Restoril and other drugs are promised by a barrage of ads to deliver sleep to minds that resist it. Before I reached for the pills I looked at the data. Specifically for evidencebased guidance I turned to comparative effectiveness research. Thats the study of the effects of one therapy against another therapy. This kind of headtohead evaluation offers ideal data to help patients and clinicians make informed treatment decisions. As obvious as that seems its not the norm. Most clinical drug trials for instance compare a drug with a placebo because thats all thats required for F.D.A. approval. In recognition of this in recent years more federal funding http has become available for comparative effectiveness research. When it comes to insomnia comparative effectiveness studies reveal that sleep medications arent the best bet for a cure despite what the commercials say. Several clinical trials have found that theyre outperformed by cognitive behavioral therapy. C.B.T. for insomnia or C.B.T.I. goes beyond the sleep hygiene http_rmoduleinline most people know though many dont employ  like avoiding alcohol or caffeine near bedtime and reserving ones bed for sleep not reading or watching TV for example. C.B.T. adds  through therapy visits or via selfguided treatments http  sticking to a consistent wake time even on weekends relaxation techniques and learning to rid oneself of negative attitudes and thoughts about sleep. One randomized trial httpjama.jamanetwork.comarticle.aspxarticleid compared C.B.T. with the active ingredient in Restoril in patients  years and older evaluating differences for up to two years. It found that C.B.T. led to larger and more durable improvements in sleep. Longterm C.B.T. alone even outperformed the combination of C.B.T. and Restoril. Another trial httparchinte.jamanetwork.comarticle.aspxarticleid focused on  to yearolds found that C.B.T. outperformed Ambien alone. Adding Ambien to a C.B.T. regimen did not lead to further improvements. Yet another trial http found that patients experienced greater relief from insomnia with C.B.T. than with the sleep drug zopiclone. Patients report that they prefer C.B.T. for insomnia over drug therapy http A systematic review http of C.B.T. for insomnia published in the Annals of Internal Medicine on Monday quantifies how much relief it can provide. Combining data from  clinical trials which included over  patients with chronic insomnia the authors calculated sleep improvements after C.B.T. treatment relative to no treatment. On average treated patients fell asleep almost  minutes faster and were awake in the night almost half an hour less. The total amount of time that they were sleeping when in bed increased by nearly  percent. These results are similar to http or better than improvements from many sleep drugs httpjama.jamanetwork.comarticle.aspxarticleid and lasted longer. My experience is consistent with these averages. The C.B.T. treatment I received through an online program recommended by my doctor http also included keeping careful track of how much sleep I got each night. This proved very helpful. It demonstrated progress  the nights in which I got only four or five hours of sleep became less common and on average my nights of sleep lengthened by  minutes. My sleep log also helped me be more objective. Many nights I might have considered bad  and fretted over  were ones in which I got only one hour less sleep than my target of seven hours. Recognizing thats not really so bad helped me relax and relaxing helped me get more and better sleep. Improvements like mine and those reported in the study http bring sleep statistics for those with insomnia quite close to those without it. This further emphasizes the point that many insomniacs arent that different from normal sleepers. Many sleep fine most nights but also have more frequent nights of insufficient sleep than normal sleepers would experience. A big part of the difference may be how insomniacs perceive their sleep performance and the negative messages they give themselves about their poor sleep and how it will affect their daily lives. C.B.T. practitioners learn that if you label a night of sleep bad and expect a bad day to follow a bad night of sleep youre more likely to get it as well as more likely to be anxious the next time you attempt to sleep. In this way unless exacerbated by physical causes  like sleep apnea or restless leg syndrome  insomnia is a condition of the mind that then infects the body. Like a patch on faulty software C.B.T. reorients ones thinking and behavior so that sleep is first thought to be and then soon after actually is a more positive experience. Drugs on the other hand just treat insomniacs symptoms without addressing the underlying cause which is why the relief they provide may be less durable. For me and many patients C.B.T. works. httptheincidentaleconomist.comwordpresscognitivelybehavingmyself And as studies show it works better than drugs. That moment with my children a couple of years ago was the last time I fell asleep reading to them."