While we discussed sleeping pills on episode 11 of the podcast, there is a lot of unfinished business here. A recent conversation with a distinguished and highly educated colleague about sleeping pills made me question my practice and the practices of many providers. In this episode we will:Examine the role of cognitive behavioral therapy for insomnia patients who do not have the resources, time, or interest in participating in the therapyExplore the differences in sleep clinics in terms of the demand for these medications. Are these drugs mainly a tool for primary care doctors or do sleep medicine specialist rely on them as a part of their insomnia toolbox?Review the data on the newest family of hypnotics, the orexin receptor antagonists, in particular their effects on sleep latency and decreasing wake time after sleep onset (WASO)Discuss the absolute lack of evidence linking any changes seen in sleeping pill sleep use and improved health/performance in their usersTouch upon the proper/ethical ways in which hypnotic data should be shared with patients who are using these drugs. If a drug is helping someone who "cannot sleep" to sleep through the night, what does it mean to withhold this data?Accepting that these medications may change sleep in very small but statistically meaningful ways, how are we as providers supposed to square these changes with the very different problems our patients bring to our clinic.Produced by: Maeve WinterMore Twitter: @drchriswinter IG: @drchriwinter Threads: @drchriswinter Bluesky: @drchriswinter The Sleep Solution and The Rested Child Thanks for listening and sleep well!

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