Chronic insomnia is among the most common sleep disorders, with about 30 percent of adults reporting symptoms, according to the American Academy of Sleep Medicine. These symptoms include having a hard time initiating sleep, struggling to maintain sleep, not being able to fall back asleep, and just poor sleep quality. While prescription sleeping pills are a popular solution, the necessary dose may be up for debate.

In a new study from the Perelman School of Medicine at the University of Pennsylvania, researchers suggest insomniacs may be able to “get relief from as little as half of the drugs.” Not only could they benefit from a smaller dose but they might even get relief by taking placebo pills. These suggestions are in “stark contrast” to standard practices.

"The clinical effects of sleeping pills cannot be relied on to last forever, and long-term use increases risk of psychological dependence and side effects including daytime drowsiness, nausea, and muscle pain," said senior author Dr. Michael Perlis, an associate professor in Penn's Department of Psychiatry and director of the Penn Behavioral Sleep Medicine Program, in a press release. "Our research found that changing the industry standard for maintenance therapy can maintain treatment responses and lower the incidence of side effects."

Perlis and his team studied 74 chronic insomniacs who had been taking 10 milligrams (mg) of Ambien, a sleeping pill clinically known as zolpidem, for four weeks. Those who were benefiting from the treatment were divided into three dosing groups for 12 weeks, in which they’d receive either a nightly dose of 5 to10 mg, “intermittent dosing” of 10 mg for up to five days a week, or “partial reinforcement” via nightly pills that were part Ambien and part placebo.

Each dose was effective in getting insomniacs to fall and stay asleep. But the intermittent dosing group reported worse sleep and more severe insomnia symptoms than any other group.

“Our findings also go against the standard practice of 'start low and go slow,' in favor of a 'start high and go low' dosing strategy in which a patient starts with 10 mg nightly and then when the desired result is reached, switch to either a lower nightly dose or intermittent dosing with placebos on non-medication nights,” Perlis said. “The full dose may or may not be required to get the initial effect, but certainly maintaining the effect can be done with less medication.”

Perlis added that the placebo aspect of his study is a “particularly novel” finding because it suggests insomniacs could benefit from the sleep capsules themselves. More importantly, this effect could lessen the amount of medication needed to keep insomnia symptoms at bay over time. That’s great news considering sleeping pills have, in some cases, led to addiction.

Source:  Perlis M, et al. Durability of treatment response to zolpidem with three different maintenance regimens: a preliminary Study. Sleep Medicine. 2015.