ريتشارد دوكنز's Blog, page 744
June 8, 2015
Good Snooze For Insomniacs — Therapy Is as Effective as Sleep Drugs
Imagine the following scenario: You have a big presentation at work tomorrow and know you need a good night’s sleep tonight so you don’t look tired or forget your lines. You get to bed at a reasonable hour but can’t turn off your anxiety and begin mentally berating yourself about your inability to fall asleep, which only prolongs your wakefulness. Eventually, you get frustrated and hit the medicine cabinet so you can finally get some much-needed shuteye.
Sound familiar?
One in three adults report problems with insomnia, and when you’re feeling stressed or anxious, it is easy to pop some sleep aids for a quick fix every so often. Usually this helps, but for the 5 to 15 percent of adults suffering from chronic insomnia, relying on prescription pharmaceuticals such as benzodiazepines and related “Z drugs” (such as Ambien or Lunesta) is not an attractive option. These compounds can present a risk of chemical or psychological dependence, and patients often develop a tolerance to their effects over time. As part of efforts to provide patients with more options, some doctors lately have proposed psychological interventions such as cognitive behavioral therapy for insomnia (CBT-i).
CBT is a kind of talk therapy used to treat a variety of mental illnesses. At its foundation is a model known as the “vicious circle,” also known as spiraling. The vicious circle explains how negative thoughts lead to feelings and then to self-destructive behaviors, and so on. CBT is a technique that intervenes when these negative thoughts start, with the goal of influencing the behavior that follows.
For insomnia, treatment is administered in five phases: Therapists prompt their patients to identify negative beliefs about sleep that might contribute to insomnia, such as an irrational fear of not getting enough sleep, and then explains why these ideas are unhelpful or suggests alternative, more positive thoughts. In the second part of the treatment, stimulus control, therapists try to maximize the association of the bed with sleep by instructing patients on behavioral changes such as avoiding stimulating activities in the bedroom. Third, they advise patients to go to bed only when sleepy, with the idea of minimizing the amount of time there spent lying awake. Fourth, they make recommendations on how to keep good “sleep hygiene,” which refers to environments and habits that promote sound sleep, such as avoiding daytime naps and limiting caffeine intake before bed. Finally, therapists suggest patients try relaxation techniques such as meditation and mindfulness just before bed to try to quiet their racing minds.
Physicians at the Melbourne Sleep Disorders Center (MSDC) in Australia recently undertook a systematic review and meta-analysis of studies pertaining to the efficacy of CBT-i in the treatment of chronic insomnia. James Trauer, a sleep physician at MSDC and lead author of the paper, says he undertook the review because he was surprised by how few of his patients have tried or even heard of CBT-i, “despite it being the most effective technique, as it gets at the core of the problem, which is frustration with time awake in bed.” Based on the results of the studies they analyzed, the authors concluded that CBT-i is effective and a good alternative to pharmacological intervention for the treatment of chronic insomnia. Their findings were published in Annals of Internal Medicine on June 8.
Out of 292 citations and 91 full-text articles, the authors selected 20 trials that met their selective criteria — ruling out studies that, for example, incorporated fewer than three of the five components of CBT-i or only included patients that had other medical conditions as well as insomnia. These studies measured four determinants of sleep quality: time taken to fall asleep, time spent awake throughout the night after initially falling asleep, total sleep time and sleep efficiency (the total sleep time divided by the total recorded time). The authors reported the average of the results of all 20 studies, which showed that after participating in a course of CBT-i, patients fell asleep 19 minutes earlier, spent 26 fewer minutes awake in the middle of the night, got 7.6 more minutes of sleep overall, and improved their sleep efficiency by almost 10 percent.
Although the change in total sleep time was not statistically significant, the remaining three measures showed marked improvement. Based on these statistics, the authors reported that CBT-i resulted in similar levels of improvement to those measured in trials of benzodiazepines for treating insomnia but without the risk of side effects associated with such pharmaceuticals. The authors did not include comparisons with trials of Z drugs, despite their rise in popularity in the past several years. Because of the recentness of their development, data on their long-term effects and safety is limited.
Of greatest significance, however, was that the effects of CBT-i were found to be more sustainable in the long run than those of pharmacological interventions. Charles Morin, a cognitive neuroscientist at Laval University in Quebec who was not involved in the study, points out that CBT-i provides a more lasting solution than pills alone because it addresses the underlying psychological and behavioral factors that perpetuate insomnia over time. This means the CBT-i option, compared with a lifetime of taking pharmaceuticals, “is likely to be a cost-beneficial investment in the long run,” Morin says.
Although the findings have implications for managing insomnia’s symptoms, there are caveats. The studies included in the review only measured quality of sleep and did not address the impact of CBT-i quality of life and other factors. Insomnia has consequences beyond the seven or eight hours spent in bed, including health problems, psychological distress, and economic burden due lost productivity.
In addition, pursuing CBT-i requires more time and motivation than taking a pill before bedtime. Sleep medications are attractive because they allow insomniacs to take one pill before bed that helps them fall asleep and stay asleep without any effort on their part. With CBT-i, one of the recommendations of stimulus control, for example, is leaving the bed if unable to fall asleep after 15 minutes and trying again later. “In the age of personalized medicine, patients may be wondering if the trade-off of getting out of that nice warm bed in the middle of the night when unable to sleep is worth it to get only 7.6 more minutes of sleep,” explains Patricia Haynes, a psychiatrist at the University of Arizona who was not involved in the review. Studies establishing that CBT-i directly improves quality of life would be required to show CBT-i is truly a better alternative to all pharmacological intervention.
If CBT-i proves to be the best option for troubled sleepers, researchers will also need to find ways to spread the word about this treatment. In contrast to the marketing campaigns common among pharmaceutical companies, behavioral treatments often go unnoticed. And, even with awareness of CBT-i, patients may not have the time, money or inclination to work with a psychotherapist on a regular basis.
One solution is an online app called Sleepio, developed by University of Oxford neuroscientist Colin Espie, that allows people to input their sleep patterns and negative thoughts about sleep, then generates a personalized CBT-i plan. The program “rings a bell with people because it is engaging, imaginative and evidence-based,” Espie says.
The MSDC meta-analysis comes at a time when society has become highly aware of the heavy physical and emotional burden of insomnia. Chronic insomnia puts people at risk for countless health conditions, including hypertension, diabetes, and depression, as well as increases the likelihood of substance abuse and vehicular accidents. Indeed, the studies provide evidence of CBT-i’s efficacy but they also provide sufferers with a choice as to how they want to manage their care.
“The most important message for patients,” Trauer says, “is that there is an effective treatment out there that is safe, doesn’t rely on popping pills, and gets to the core of the problem.”
Here’s What Ariel Would Look Like If She Evolved In The Deep Ocean
Photo credit:
Disney
Princess Ariel – the Disney princess of the water. Living under the sea in the monarchical society of Atlantica, Ariel is the seventh-born daughter of the reigning family. Not fancying her chances of becoming queen any time soon, Ariel falls in love with the land-based Prince Eric.
But what would she have looked like if she hadn’t lived in the seemingly part-humanoid-friendly waters of Atlantica?
What Is This Bizarre Slimy Green Creature?
Photo credit:
Why is it pulsing? / Wei Cheng Jian
What is this creature in the video below and why is its every move terrifying?
[youtube https://www.youtube.com/watch?v=GQcer...]
Wonder no more: the green gloop is a ribbon worm (Nemertea) and the pink projection that curves over its body is its proboscis tongue.
Spain Has First Case Of Diphtheria In 28 Years Thanks To Anti-Vaxxers
Photo credit:
Pixs4u via Shutterstock
A six-year-old boy who had not been vaccinated is Spain’s first case of diphtheria in 28 years. The young boy, from the Catalan city of Olot, is reportedly very ill and is being treated with antitoxin. The parents, who had chosen not to vaccinate their child, are “devastated” and have now had their younger daughter immunized as a result.
Filmmaker Gets Up Close And Personal With Massive Hammerhead Sharks
Photo credit:
Hammerhead sharks are friends, not food / Bill Fisher / Media Drum World
Underwater filmmaker and shark enthusiast Joe Romeiro has come closer to hammerhead sharks than probably most people would feel comfortable.
In an astounding series of photos, Romeiro is seen fearlessly petting the unusually shaped apex predators, feeding them and holding their noses as though they were household pets.
NASA To Invest In Eco-Friendly Commercial Supersonic Jets
Photo credit:
NASA
In 2003, the last supersonic commercial Concorde planes in operation touched down on the runway for the final time. The planes had made just shy of 50,000 flights over their 26 years in operation, but due to various reasons, both political and technical, the aluminum birds had come in to roost.
Newly Developed Artificial Limb Lets Amputees “Feel”
Photo credit:
AFP
First skin, now a limb: researchers have developed a “feeling” prosthetic leg that not only simulates some of the sensations that would normally be felt by a foot, but also helps to alleviate the phantom pain experienced by many amputees.
Coydogs And Lynxcats And Pizzlies, Oh My
Photo credit:
Thanks to human activity, native animals and plants are expected to hybridize more than ever. Is that a problem — or a solution? / Deanna Wright
Native wolves had been eradicated and the forests of the eastern United States long cut down when residents of western New York first began to notice the arrival of coyotes in the 1940s.
The coyotes of the Rocky Mountains and Great Plains were lithe and quick, usually weighing less than 30 pounds. The newcomers were different.
Researchers Inject Tiny, Rolled-Up Electronics into the Brain Using a Syringe
Photo credit:
Bright-field image showing the mesh electronics being injected through sub-100 micrometer inner diameter glass needle into aqueous solution. Lieber Research Group / Harvard University
Researchers have developed stretchy, bendy electronics that are so thin they can be rolled up and jammed into a small needle with a 0.1-millimeter diameter, then injected into living tissue. Within an hour of being injected into the brains of live mice, the electronics unfurled and began monitoring biological activity. The work is described in Nature Nanotechnology this week.
June 6, 2015
The Myth of “Female Viagra”
Viagra does not affect the desire for sex in men, it just helps with the hydraulics. The drug boosts blood flow to the genitals so men can get and sustain an erection. Yet the female libido drug that passed muster at a U.S. Food and Drug Administration advisory panel this week will not live up to the “female Viagra” hype it’s been getting. The new drug, Flibanserin, is designed to alter women’s brain chemistry over time to help increase sex drive. Unlike Viagra, it does not spark an immediate physical change in the body.
Flibanserin is designed to address chronically low sexual desire in woman that causes distress. (The condition is distinct from fluctuations of sexual desire that occur naturally over time.) Exactly how many women experience it has been hard to pin down—one study suggests as many as one in three women, although the pharmaceutical company producing the drug told the FDA advisory panel that about 7 percent of premenopausal women have the condition, according to The New York Times. Women with the condition may still enjoy sex when they are having it but typically do not have the desire to engage in sex in the first place.
Whereas Viagra is a little blue pill men would take directly before sex to help direct that blood flow, Flibanserin needs to be taken daily. Over time it can affect two neurotransmitters in the brain and that may help influence libido. Exactly how Flibanserin restores desire, however, is murky. The drug acts to increase the neurotransmitter dopamine—a chemical that modulates motivation and reward—by binding with dopamine receptors. It also suppresses serotonin—a neurochemical linked to appetite and feelings of fulfillment or satiety—by acting on serotonin receptors.
Other drugs on the market target some aspects of sex for women, such as helping treat vaginal dryness, but none have been approved for treating low female sexual arousal. Flibanserin was originally developed as an antidepressant drug by pharmaceutical company Boehringer Ingelheim although it is now produced by Sprout Pharmaceuticals. Several other antidepressants are currently prescribed off-label to treat sexual desire disorders but some of those drugs have can cause unwanted side effects such as irregular heartbeat or shortness of breath. Flibanserin, in fact, was rejected by the FDA twice for side effects that include fainting spells and low blood pressure.
The FDA advisory panel that voted on June 4 to recommend approval of the drug did not discount those risks. They came to their decision after hearing testimony from women about how the drug significantly altered their lives for the better. The panel voted 18–6 in favor of putting the drug on the market alongside information about its side effects. Panelists agreed that the benefits of the drug were not large but still meaningful for patients. The FDA is not obligated to approve the drug now but the agency often follows the recommendations of its advisory panels.
Yet whichever way the FDA goes with their approval one thing remains clear: calling it “female Viagra” is misleading.
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