December 20, 2012 at 7:00 am
Austin FraktHere’s the conclusion of a new meta-analysis of currently approved “Z drugs” (e.g., Lunesta, Ambien, Sonata) for insomnia:
This study of FDA data shows that Z drugs improve objective and subjective sleep latency compared with placebo, particularly in younger and female patients. The size of this effect, however, is small and needs to be balanced with concerns about adverse effects, tolerance, and potential addiction. The placebo response accounted for about half of the drug response. This suggests that increased attention should be directed at psychological interventions for insomnia.
Psychological interventions include, of course, cognitive behavioral therapy. (That’s a link to a search of this blog on CBT and insomnia. I’ve written a ton on the subjects, including from personal experience.)
by foosion on December 20th, 2012 at 09:41
Interesting
I take Ambien to help sleep on long flights. Two 10mg tabs are usually enough for about 5 hours sleep. Zolpidem, a generic, hasn’t worked as well. I suppose that’s because the placebo effect is weaker given my uncertainty about whether it’s an adequate substitute.
by Aaron Carroll on December 20th, 2012 at 09:54
Run your own RCT. Try and blind yourself to which drug (generic or brand name) you’re taking and see if the results are different!
by foosion on December 20th, 2012 at 10:03
Good idea!
The problem is the tablets are different shapes, which makes it harder to test blind. I suppose I could put them into capsules so the test would be blind, but don’t have empty capsules (or capsules I could empty).
Any suggestions?
by Austin Frakt on December 20th, 2012 at 10:14
Can you feel the shape in your open palm and mouth? If not, put several of each type in an opaque pill container. You ought to be able to open the bottle, slide one pill into your palm, and take it all with your eyes closed. If you accidentally dump more than one pill into your palm, just open your eyes, put them back in the bottle, and try again.
It’d be better if you could know later which one you took when. I bet you could add a step of photographing what’s in your palm still without looking!
by foosion on December 20th, 2012 at 10:48
Unfortunately, there is a substantial size difference between the generic and the branded versions.
by Austin Frakt on December 20th, 2012 at 10:59
I’m out of (good) ideas.
by foosion on December 20th, 2012 at 11:13
I’ll try to find some empty capsules or something else edible, opaque and non-reactive.
Perhaps I could wrap the tablets in breath mint strips. Create two packets, put them in the same container, take one, later open the other to find what I took.
Thanks for the suggestion
by Austin Frakt on December 20th, 2012 at 11:19
Good thinking. You really must video this whole thing, because it is starting to sound hilarious. Maybe a paper on self-administered, blinded trials could win an Ig Nobel or something.
by Aaron Carroll on December 20th, 2012 at 11:59
Don’t laugh! When I was a resident, we put every kid diagnosed with ADHD on an N of 1 trial of Ritalin. The pharmacy dispensed two weeks each of placebo, low dose, and high dose drug in a random order. Then we asked for rating scales at the end of each two week period.
Through this, we determined if Ritalin worked for each kid, and what an appropriate starting dose would be.
by Austin Frakt on December 20th, 2012 at 12:23
I do lots of N=1 work on myself, so I’m not laughing! I was just contemplating foosion’s creative yet Rube Goldberg-like, hypothetical attempts to blind himself to the different treatments. That’s what’s funny.
by David J. Littleboy on December 21st, 2012 at 11:01
Zolpidem (5 mg) works fine here. Without it, my mind will race in frantic flights of fancy when I get into bed requiring getting up and reading for a while. (I’d read under the covers with a flashlight as a kid.) Zolpidem is a reliable knockout.