Live Recordings (Sleep Medicine Trends 2026)-09 Pills or Skills

Video Transcription

Video Summary

A live pro–con debate is introduced on the resolution: “Medication is the best treatment for insomnia,” featuring sleep specialists Dr. Katie Sharkey and Dr. Daniel Buysse, with sides assigned by coin toss (Buysse pro-medication; Sharkey pro-CBT-I). A case is presented: a distressed 52-year-old woman with years of insomnia, failed sleep hygiene and melatonin, disruptive bedroom environment (TV, large dog), and anxiety history after stopping an SSRI.<br /><br />The pro-medication argument emphasizes evidence from guidelines and meta-analyses that FDA-approved hypnotics improve sleep onset and maintenance with generally low rates of reported side effects, including data suggesting sustained benefit over months and limited evidence linking benzodiazepines to dementia. It argues medications are scalable and accessible compared with CBT-I, which suffers from limited provider availability and high dropout/adherence challenges.<br /><br />The CBT-I side argues it is strongly evidence-based, first-line per multiple professional organizations, durable, and safer long-term, addressing root causes (conditioning, maladaptive beliefs, circadian/homeostatic timing) and comorbid anxiety. Access is improving via digital and brief behavioral options and emerging reimbursement pathways.<br /><br />In rebuttal and Q&A, speakers discuss real-world barriers, lack of medication algorithms, cost/coverage issues (e.g., DORAs), off-label options (gabapentin), wearable data use, tailoring stimulus control, and future combination pharmacotherapy. Audience polling shifts but remains mixed.

Keywords

insomnia treatment debate

hypnotic medications

cognitive behavioral therapy for insomnia (CBT-I)

FDA-approved sleep medications

benzodiazepines and dementia risk

dual orexin receptor antagonists (DORAs)

digital CBT-I access and adherence

sleep onset and maintenance meta-analyses