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BMJ 2006; 333 doi: (Published 06 July 2006) Cite this as: BMJ 2006;333:90
  1. Alison Tonks, associate editor (

    Older people sleep better after cognitive behaviour therapy

    Up to a quarter of people aged over 55 sleep badly, and most of this insomnia remains untreated. Those that do ask for help are often prescribed drugs that don't work very well, or for very long. Cognitive behaviour therapy probably works better, according to a clinical trial from Norway that compared six weeks of therapy with six weeks of the popular drug treatment zopiclone, or a placebo.

    Credit: JAMA

    Using home polysomnography (electroencephalography, electromyography, electro-oculography) and sleep diaries, the researchers looked for changes in total sleep time, total wake time, sleep efficiency, and time spent in valuable slow wave sleep. Cognitive therapy looked significantly better than zopiclone for three of the four outcome measures, particularly sleep efficiency (ratio of total time asleep to time spent in bed), which went up from 81.4% to 90.1% in the therapy group (n = 18) and down from 82.3% to 81.9% in the zopiclone group over six months (n = 16). Those who had therapy also got significantly more slow wave sleep than either of the other groups, but no more sleep overall.

    Credit: JAMA

    The authors say their results are clinically meaningful as well as statistically significant, and consistent with previous work showing the benefit of cognitive behaviour therapy for younger adults with insomnia. Importantly, the benefits of cognitive behaviour therapy seem to last. The older people in this trial had individual therapy that included help with sleep hygiene and learning how to relax.

    Credit: JAMA

    Outbreaks of rare fungal keratitis reported in Singapore, Hong Kong, and US

    Fungal keratitis is a sight threatening infection that's only rarely associated with wearing contact lenses. So when ophthalmologists in Singapore noticed a dramatic increase in the number of cases, they alerted the health ministry, which in turn warned opticians and other health professionals to expect more.

    A retrospective look through all public hospital records since the …

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