Getting a decent night's sleep shouldn't be such a crapshoot. But for the estimated 30% of American adults who suffer from at least occasional insomnia, nightfall is no guarantee of slumber.

    To combat wakefulness, Americans filled more than 50 million prescriptions in 2008 for sleeping pills like Ambien and spent more than $600 million on over-the-counter sleep-inducing supplements such as melatonin and valerian root. Others seek medical treatment or psychological therapy to get to sleep, while the rest of us accept our nocturnal tossing and turning as just another of life's unavoidable nuisances and gulp an extra cup of coffee the next morning to compensate.

    But despite our best efforts, about 10% of Americans still suffer from persistent insomnia （defined as difficulty initiating or maintaining sleep） - namely, falling asleep or being functionally impaired by sleepiness during the day - and researchers continue to search for its causes and cure. Now a new study in the journal Sleep suggests a surprising treatment for the sleepless: the Internet. Web-based treatments have emerged for all kinds of bad habits and disorders, such as overeating, smoking, depression - and insomnia.

    Compared with face-to-face counseling or medical treatments, online therapies are typically simpler and less expensive. Major health insurers like Blue Cross and Aetna even offer Web-based anti-insomnia programs for free. And there's growing evidence that online therapy really works: in the new Sleep study, 81% of participants who completed a five-week, online program for insomnia reported improvement in sleep.

    "There may be some unique things that you get from an Internet program, like the feeling that you are really in the driver's seat," says the study's author, clinical psychologist Norah Vincent, who adds that many of the 40 participants who completed her multimedia program reported both better sleep quality and less daytime fatigue than did a control group. "People like to have autonomy in solving problems. I think it motivates them more," she says.

    Based on cognitive-behavioral-therapy techniques, Vincent's virtual therapy combines videos, text and audio clips to teach the sleepless everything about good sleep hygiene, from how to relax the body before getting into bed to how not to stress out when you fail to doze off right away. （One of the worst things you can do when you can't fall asleep is lie there and dwell on the consequences of not getting enough sleep.） Participants in her study were asked to keep digital sleep diaries and practice the techniques that were demonstrated onscreen. They were also allowed to download audio clips of a sleep therapist and an actor in a staged one-on-one session and listen to them on their iPods.

    While prior studies have shown that online therapy can help alleviate insomnia, little research has compared it directly with other approaches. Vincent's study, on the other hand, found that 35% of those who received online treatment reported that they were "much" or "very much" improved, compared with 50% of those who received in-person group therapy using the same behavioral-cognitive approach at Vincent's sleep clinic at the University of Manitoba in Canada. The benefit of the online strategy, of course, is that it can work for people who don't have access to face-to-face therapy.

    Some proponents of online therapy say it may actually be more effective than in-person counseling. "You don't have to worry about personalities, and you can go over the material over and over," notes Gregg Jacobs, an insomnia specialist at the University of Massachusetts Medical School, who has offered a self-guided online program for the past two years. Since patients don't have to make time for in-office appointments and can proceed at their own pace, Web-based programs have the potential to reach a much broader audience.

    But computer counseling has its detractors, particularly when it fails to get at the root of patients' sleep issues. "There is only so far you can go with it," notes Dr. S.K. Mostafavi, who runs the Advanced Sleep Medicine Services chain of sleep clinics in Southern California and has served as a sleep "guru" for the popular weight-loss reality show The Biggest Loser. Online therapy can be helpful as an educational tool, says Mostafavi, but he cautions, "You don't have the benefit of talking to a professional and finding out what is causing the insomnia." （Insomnia may be a side effect of an underlying condition, such as anxiety, Alzheimer's, arthritis or asthma, or it can result simply from poor sleep habits, like failing to keep a regular bedtime.） Vincent concedes that patients who have deeper problems - those who are depressed or suicidal - or have trouble concentrating are unlikely to benefit from the program.

    As digital therapy evolves, "one of the tricks is to identify who will respond best to online treatment," notes Dr. Michael Sateia, director of sleep medicine at Dartmouth-Hitchcock Psychiatric Associates in Lebanon, N.H. "Sleep medicine is still in its childhood, and for decades we have lived in a culture where pharmacological therapies have been the mainstay. But we are beginning to change that mentality." Sateia's center, for example, recently hired a nurse practitioner to offer more affordable group therapy as an alternative to individual counseling by a psychiatrist.

    One area that has been studied extensively is the benefits of cognitive-behavioral therapy vs. those of medication. A recent study in the Journal of the American Medical Association found that while cognitive therapy alone or in combination with medication worked equally well to treat insomnia in the short term, patients fared better over the long term with talk therapy alone. "Cognitive therapy should be a first-line approach," says the study's lead author, Charles Morin, "but many people do not have access to it."

    With demand far outstripping supply for therapists trained to treat sleep problems, online programs are "a very innovative and cost-effective way of looking at insomnia therapy," says Morin. There may be no single cure-all for sleeplessness, but such promising alternatives should help more night owls wake in the morning feeling refreshed.

    睡個(gè)好覺，不該這么麻煩。但是據(jù)估計(jì)，30%的美國(guó)成年人都受到失眠困擾--至少有時(shí)候是這樣。夜幕降臨，未必就帶來(lái)酣睡。

    為應(yīng)對(duì)失眠，2008年美國(guó)人花費(fèi)5000美元購(gòu)買安必恩等藥物，6億美元購(gòu)買褪黑素、纈草根等非處方催眠產(chǎn)品。一些人尋求醫(yī)學(xué)或心理療法，剩下的只能無(wú)可奈何，在黑夜中輾轉(zhuǎn)反側(cè)，第二天到來(lái)，多灌一杯咖啡，保持清醒狀態(tài)。

    不管我們付出多大努力，仍有10%的美國(guó)仍長(zhǎng)期受到失眠困擾（難以入睡，難以保持睡眠）--白天瞌睡，或者因勞累引起效率低下--科學(xué)研究人員仍舊在探索這種情況如何造成，應(yīng)該如何治療�！端�眠》雜志現(xiàn)在刊登了一項(xiàng)研究，給人們提出了一種治療失眠的雷人方法：因特網(wǎng)。網(wǎng)絡(luò)療法已經(jīng)用于治療各種不良習(xí)慣和失調(diào)，如暴飲暴食、吸煙、壓抑--還有失眠。

    相比面授咨詢或醫(yī)學(xué)療法，網(wǎng)絡(luò)治療不但更加簡(jiǎn)單，而且更為經(jīng)濟(jì)。藍(lán)十字、安泰等主要健康保健機(jī)構(gòu)甚至?xí)�免費(fèi)提供網(wǎng)絡(luò)治療失眠項(xiàng)目。愈來(lái)愈多的證據(jù)顯示，在線治療真正有效：在《睡眠》新近展開的研究中，完成了為期五周的網(wǎng)絡(luò)失眠治療項(xiàng)目的參與者中，81%都稱自己睡眠得到了改善。

    "在網(wǎng)絡(luò)項(xiàng)目中，可能有某些獨(dú)特之處，比如能夠得到真正坐在駕駛座上的感覺。"研究報(bào)告作者諾拉。文森特說，這位診療心理學(xué)家還補(bǔ)充道，40名完成了她的多媒體項(xiàng)目的參與者中，許多非但睡眠質(zhì)量得到了提高，而且白天疲勞的情況和對(duì)照組相比也有所減少。"人們喜歡獨(dú)立解決問題。我覺得這對(duì)他們有激勵(lì)作用。"她說。

    文森特在認(rèn)知行為療法的基礎(chǔ)上，在虛擬療法中結(jié)合了影像、文本和音頻文件，給失眠者傳授良好的睡眠衛(wèi)生的各個(gè)方面，包括在睡前放松身體，在無(wú)法馬上產(chǎn)生困意時(shí)緩解壓力。（如果無(wú)法入睡最不明智的方法之一就是躺在那里，總想著自己睡不著。）她要求參加者寫數(shù)字睡眠日記，練習(xí)屏幕上展示的技巧。同樣，他們還可以下載睡眠治療師和演員在的一對(duì)一療程中的音頻片斷，在數(shù)字音樂播放器中播放。

    從前研究已經(jīng)顯示網(wǎng)絡(luò)療法能夠緩解失眠，但是很少有研究將其與其他療法進(jìn)行直接比對(duì)。而文森特的研究發(fā)現(xiàn)，接受網(wǎng)絡(luò)治療者中，35%都稱自己得到了"很大"或"明顯"改善；相比之下，在加拿大曼尼托巴大學(xué)文森特的睡眠診所中使用同樣的行為認(rèn)知療法，進(jìn)行現(xiàn)場(chǎng)治療的病人中，50%稱改善較為明顯。當(dāng)然，網(wǎng)絡(luò)療法有一個(gè)好處：不管是否有機(jī)會(huì)獲得面對(duì)面治療，對(duì)病人都能奏效。

    網(wǎng)絡(luò)療法的支持者說，這比面授咨詢更加有效。"人們不用擔(dān)心什么個(gè)性問題，也不用一遍遍地讀材料。" 馬薩諸塞大學(xué)醫(yī)學(xué)院失眠專家格雷格雅各布說，過去兩年中，他推出了一個(gè)自導(dǎo)網(wǎng)絡(luò)項(xiàng)目。病人無(wú)需辦公室預(yù)約，并能按照自己的速度進(jìn)行，因此網(wǎng)絡(luò)療法廣泛受眾潛力更大。

    但是也有人批評(píng)電腦咨詢，尤其是電腦無(wú)法深入病人失眠根源。"現(xiàn)在計(jì)算機(jī)能做的也就這么多了。"S.K. 穆斯塔法博士稱。穆斯塔法博士在南加利福尼亞州經(jīng)營(yíng)先進(jìn)睡眠醫(yī)療服務(wù)連鎖診所，曾經(jīng)在流行減肥真人秀"瘦身達(dá)人"中出任睡眠古魯。穆斯塔法說，網(wǎng)絡(luò)療法能夠起到教育工具的幫助作用，但也警告："這樣你卻無(wú)法跟一位專家交談，找出失眠根源。"（失眠可能是某種存在問題的副作用，比如焦慮、阿爾茨海默氏癥、風(fēng)濕、哮喘，或者是其他不好的睡眠習(xí)慣--例如睡覺時(shí)間不規(guī)律--所引發(fā)。）文森特承認(rèn)，對(duì)于有著更深程度問題--比如精神壓抑、有自殺傾向--或者難以集中注意力的患者，這樣的治療很可能毫無(wú)起色。

    隨著數(shù)字療法的展開，"其中一個(gè)難題就是怎樣識(shí)別網(wǎng)絡(luò)療法會(huì)對(duì)誰(shuí)有效。"美國(guó)新罕布什爾州黎巴嫩市達(dá)特茅斯-希區(qū)柯克精神病學(xué)協(xié)會(huì)睡眠醫(yī)學(xué)主管邁克爾。薩蒂伊納說，"現(xiàn)在的睡眠醫(yī)學(xué)仍舊不成熟，幾十年來(lái)，這個(gè)社會(huì)都是把藥物治療作為主體。但是我們已經(jīng)開始轉(zhuǎn)變這種觀念。"最近薩蒂爾納中心就雇用了一名護(hù)師提供經(jīng)濟(jì)的集體治療，用以替代精神病醫(yī)師的個(gè)別咨詢。

    認(rèn)知行為療法相對(duì)藥物療法已經(jīng)得到了廣泛研究。《美國(guó)醫(yī)學(xué)會(huì)雜志》最近刊登的研究表明，雖然短期看來(lái)，單獨(dú)使用認(rèn)知療法，或者將其同藥物療法結(jié)合使用在治療失眠方面都有很好的療效，但是長(zhǎng)期看來(lái)，病人使用單獨(dú)的言語(yǔ)療法更加有益。"認(rèn)知療法應(yīng)是首選，"報(bào)告主要作者查爾斯。莫寧說，"但很多人都無(wú)法獲得。"

    經(jīng)過培訓(xùn)能夠治療睡眠問題的醫(yī)生，供遠(yuǎn)遠(yuǎn)大于求，因此網(wǎng)絡(luò)療法是"一個(gè)非常創(chuàng)新、經(jīng)濟(jì)的失眠療法。"莫寧說。治療失眠的"萬(wàn)靈丹"可能并不存在，但是這樣前景光明的替代療法應(yīng)該讓更多的"貓頭鷹"在早上起床的時(shí)候，神清氣爽。