Sleep Care

Pill or Placebo?

Recently, 60 Minutes examined the work of Harvard scientist Irving Kirsch, who has spent years study the placebo effect: a phenomenon that occurs when a “non-medicine” pill (such as a sugar pill) is given to a participant who believes that it is actually medicine and will improve whatever condition it is being taken for. Kirsch has found that the beneficial effects of medicines are due primarily to patients’ strong beliefs about how well the medicine will work, as opposed to the actual chemical interactions of the medication in the body. While he initially studied anti-depressants, Kirsch expanded his work to include tranquilizers, barbituates, and other medicines. Sleeping pills are a big business. People in Britain spent over 50 million pounds (about 78 million US dollars) last year. In 2006, Americans spent over three billion dollars alone on Lunesta and Ambien, two popular sleeping aids. Kirsch’s work begs the question: is this money well spent? A Complex Behavior Determining the effectiveness of sleeping pills beyond an individual basis can be difficult due to the complex nature of sleep. Unlike other conditions that medications may be prescribed for, sleep cannot be entirely limited or


isolated to just a series of chemical interactions in the brain (outside of a laboratory setting). For example, the circadian rhythms that play a vital role in regulating sleep are significantly affected by exposure to sunlight, which in turn affects melatonin levels that promote sleepiness or wakefulness. While supplemental melatonin (or drugs mimicking melatonin) can be taken, its effectiveness is significantly tied to the time during the day that the medication is taken, as well as how much exposure the individual has had to sunlight during the day. In this scenario, the benefit gained from the chemical interactions of the supplemental melatonin or melatonin-like drug is secondary to behavioral modifications—namely, taking the drug at the proper time and avoiding sunlight late in the day. The fact that behavior modifications can play a significant role in improving sleep is also the basis for developing good sleep hygiene, which is one of the most important ways to treat sleep problems (and often, the most cost-effective). However, as the usefulness of Cognitive Behavioral Therapy (CBT) suggests, there is a psychological component to sleep that can be evaluated and treated for those suffering from a poor night’s rest. In some cases, poor sleep may be due to a physical cause (such the airway narrowing for people with obstructive sleep apnea). All of these different pathways to improving sleep indicate how much more complex our sleep is than

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just a series of chemical interactions to be affected by medication. Sleeping Pills: Effective or Not? So, are sleeping pills effective? It is impossible to know what benefits are coming from the chemicals within a medication and what benefits are coming from the mind. One point that most researchers and health professionals agree on is that the mind does play a significant and sometime powerful role in one’s wellness and quality of life. Relative to sleep, this concept would suggest that the sleep therapies relying on mental training and relaxation might be an underestimated and invaluable tool in achieving restful sleep. As with any medication, there can be risks to taking it and side effects can develop, particularly for long-term users. For those concerned about these, taking a different approach to treating their sleeping problems—whether behavioral, psychological, or physical—may be the most effective method of all. However, it is important to remember that for a medicine to be cleared for public use by the FDA, trials and studies need to be done that demonstrate its increased effectiveness over a placebo. The fact that sleeping pills are available to the public suggests that they are effective to some degree, and if you have been prescribed a medicinal treatment by a medical professional you should not discontinue your therapy without first discussing with your physician.

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