SCIENTIFIC RESEARCH

Hypnosis and Insomnia

Numerous studies that are summarized below have shown without doubt that Mind-Body Therapies for insomnia are effective. These treatments include hypnosis, self-hypnosis, relaxation, mental imagery, cognitive-behavioral therapy, and sleep hygiene. (Note: I combine these techniques even though I call it "hypnotherapy". – Kathy Doner, MD)

This approach is in fact superior to medication in the long-term follow-up and is useful in withdrawing people from the chronic drug use. It is very cost-effective with 2-6 visits. It therefore should be considered a first-line intervention with chronic insomnia.

Separate studies have shown that it works for children and for the elderly, as well as for mid-age groups and for hot-flash sleep disturbances. In addition, it improves other symptoms that are treatable with hypnosis.

An excellent review in 2003 of Mind-Body Medicine Therapies has concluded:

"Numerous trials as well as several reviews and meta-analyses have examined the efficacy of Mind-Body Therapies for insomnia. A 1994 meta-analysis of 59 studies reported that psychological interventions averaging 5 hours produced reliable changes in sleep-onset latency and time awake after sleep. A 1996 NIH consensus panel concluded that these therapies produce significant changes in some aspects of sleep.

Mind-Body Therapies can also be helpful in treating late-life insomnia. A randomized trial found that cognitive-behavioral therapy (alone and in combination with pharmacologic therapy) was effective in reducing time awake after sleep onset in elderly patients. Whereas drug therapy alone was also more effective than placebo, only those patients using the behavioral approach maintained treatment gains at follow-up.

Although pharmacological treatments produce somewhat faster sleep improvements in the short term, behavioral approaches in the intermediate term (4-8 weeks) show comparable effects, and in the long-term (6-24 months) behavioral approaches show more favorable outcomes than drug therapies."

(Access this review article Mind-Body Medicine: State of the Science: Implications for Practice by Astin and Shapiro, Journal of the Board of Family Medicine, March-April 2003: vol 16(2):131-147 at www.jabfm.org/content).

More recent studies are listed below:

Hypnosis for treatment of insomnia in school-age children: a retrospective chart review.
Anbar RD, Slothower MP. BMC Pediatr. 2006 Aug 16;6:23.

The purposes of this study were to document psychosocial stressors and medical conditions associated with development of insomnia in school-age children and to report use of hypnosis for this condition.

Results: Younger children were more likely to report that the insomnia was related to fears. Two or fewer hypnosis sessions were provided to 68% of the patients. Of the 70 patients reporting a delay in sleep onset of more than 30 minutes, 90% reported
a reduction in sleep onset time following hypnosis. Of the 21 patients reporting nighttime awakenings more than once a week, 52% reported resolution of the awakenings and 38% reported improvement. Somatic complaints amenable to hypnosis
were reported by 41%, including chest pain, dyspnea, functional abdominal pain, habit cough, headaches, and vocal cord dysfunction. Among these patients, 87% reported improvement or resolution of the somatic complaints following hypnosis.

CONCLUSION: Use of hypnosis appears to facilitate efficient therapy for insomnia in school-age children and resolve or improve somatic complaints.

Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial.
Sivertsen B, Omvik S, Pallesen, et al. JAMA. 2006 Jun 8;295(24):2851-8.

Insomnia is a common condition in older adults and is associated with a number of adverse medical, social, and psychological consequences. Previous research had suggested beneficial outcomes of both psychological and pharmacological treatments, but blinded placebo-controlled trials comparing the
effects of these treatments were lacking.

CONCLUSION: These results suggest that interventions based on cognitive behavioral therapy are superior to zopiclone treatment both in short- and long-term management of insomnia in older adults.

Psychological treatment for insomnia in the management of long-term hypnotic drug use: a pragmatic randomised controlled trial.
Morgan K, et al. Br J Gen Pract. 2003 Dec;53(497):923-8.

The objective was to evaluate the clinical and cost impact of providing cognitive behaviour therapy (CBT) for insomnia (comprising sleep hygiene, stimulus control, relaxation and cognitive therapy components) to long-term hypnotic drug
users in general practice.

Results: At 3- and 6-month follow-ups patients treated with CBT reported significant reductions in sleep latency, significant improvements in sleep efficiency, and significant reductions in the frequency of hypnotic drug use (all P<0.01). Among CBT treated patients SF-36 scores showed significant improvements in vitality at 3 months (P<0.01). Older age presented no barrier to successful treatment outcomes. The total cost of service provision was 154.40 per patient, with a mean incremental cost per quality-adjusted
life-year of 3416 (at 6 months). However, there was evidence of longer term cost offsets owing to reductions in sleeping tablet use and reduced utilization of primary care services.

CONCLUSIONS: In routine general practice settings, psychological treatments for insomnia can improve sleep quality and reduce hypnotic consumption at a favorable cost among long-term hypnotic users with chronic sleep difficulties.

Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison.
Jacobs GD, et al.. Arch Intern Med. 2004 Sep 27;164(17):1888-96.

Chronic sleep-onset insomnia is a prevalent health complaint in adults. Although behavioral and pharmacological therapies have been shown to be effective for insomnia, no placebo-controlled trials have evaluated their separate and combined effects for sleep-onset insomnia. The objective of this study was to evaluate the clinical efficacy of behavioral and harmacological therapy, singly and in combination, for chronic sleep-onset insomnia.

Results: In most measures, CBT was the most sleep effective intervention; it produced the greatest changes in sleep-onset latency and sleep efficiency, yielded the largest number of normal sleepers after treatment, and maintained therapeutic
gains at long-term follow-up. The combined treatment provided no advantage over CBT alone, whereas pharmacotherapy produced only moderate improvements during drug administration and returned measures toward baseline after drug use discontinuation.

CONCLUSIONS: These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia. Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large numbers of patients with insomnia.

Mind control of menopause.
Younus J, wt al. Womens Health Issues. 2003 Mar-Apr;13(2):74-8.

The primary objective of this study was to observe the effect of hypnosis on hot flashes (HF) and overall quality of life in symptomatic patients. A secondary objective was to observe the effect of hypnosis on fatigue. The frequency, duration and severity of HF were significantly reduced. The overall quality of life was also improved. The subjects enjoyed better sleep and had less insomnia). There was a significant improvement on current fatigue level.

CONCLUSIONS: We conclude that hypnosis appears to be a feasible and promising intervention for HF, with a potential to improve quality of life and insomnia.Although improvement in current level of fatigue was observed in this pilot study, total fatigue improvement did not reach statistical significance.

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