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.

    睡個好覺，不該這么麻煩。但是據估計，30%的美國成年人都受到失眠困擾--至少有時候是這樣。夜幕降臨，未必就帶來酣睡。

    為應對失眠，2008年美國人花費5000美元購買安必恩等藥物，6億美元購買褪黑素、纈草根等非處方催眠產品。一些人尋求醫學或心理療法，剩下的只能無可奈何，在黑夜中輾轉反側，第二天到來，多灌一杯咖啡，保持清醒狀態。

    不管我們付出多大努力，仍有10%的美國仍長期受到失眠困擾（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--科學研究人員仍舊在探索這種情況如何造成，應該如何治療。《睡眠》雜志現在刊登了一項研究，給人們提出了一種治療失眠的雷人方法：因特網。網絡療法已經用于治療各種不良習慣和失調，如暴飲暴食、吸煙、壓抑--還有失眠。

    相比面授咨詢或醫學療法，網絡治療不但更加簡單，而且更為經濟。藍十字、安泰等主要健康保健機構甚至會免費提供網絡治療失眠項目。愈來愈多的證據顯示，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絡失眠治療項目的參與者中，81%都稱自己睡眠得到了改善。

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

    文森特在認知行為療法的基礎上，在虛擬療法中結合了影像、文本和音頻文件，給失眠者傳授良好的睡眠衛生的各個方面，包括在睡前放松身體，在無法馬上產生困意時緩解壓力。（如果無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。）她要求參加者寫數字睡眠日記，練習屏幕上展示的技巧。同樣，他們還可以下載睡眠治療師和演員在的一對一療程中的音頻片斷，在數字音樂播放器中播放。

    從前研究已經顯示網絡療法能夠緩解失眠，但是很少有研究將其與其他療法進行直接比對。而文森特的研究發現，接受網絡治療者中，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文森特的睡眠診所中使用同樣的行為認知療法，進行現場治療的病人中，50%稱改善較為明顯。當然，網絡療法有一個好處：不管是否有機會獲得面對面治療，對病人都能奏效。

    網絡療法的支持者說，這比面授咨詢更加有效。"人們不用擔心什么個性問題，也不用一遍遍地讀材料。" 馬薩諸塞大學醫學院失眠專家格雷格雅各布說，過去兩年中，他推出了一個自導網絡項目。病人無需辦公室預約，并能按照自己的速度進行，因此網絡療法廣泛受眾潛力更大。

    但是也有人批評電腦咨詢，尤其是電腦無法深入病人失眠根源。"現在計算機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營先進睡眠醫療服務連鎖診所，曾經在流行減肥真人秀"瘦身達人"中出任睡眠古魯。穆斯塔法說，網絡療法能夠起到教育工具的幫助作用，但也警告："這樣你卻無法跟一位專家交談，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、風濕、哮喘，或者是其他不好的睡眠習慣--例如睡覺時間不規律--所引發。）文森特承認，對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起色。

    隨著數字療法的展開，"其中一個難題就是怎樣識別網絡療法會對誰有效。"美國新罕布什爾州黎巴嫩市達特茅斯-希區柯克精神病學協會睡眠醫學主管邁克爾。薩蒂伊納說，"現在的睡眠醫學仍舊不成熟，幾十年來，這個社會都是把藥物治療作為主體。但是我們已經開始轉變這種觀念。"最近薩蒂爾納中心就雇用了一名護師提供經濟的集體治療，用以替代精神病醫師的個別咨詢。

    認知行為療法相對藥物療法已經得到了廣泛研究。《美國醫學會雜志》最近刊登的研究表明，雖然短期看來，單獨使用認知療法，或者將其同藥物療法結合使用在治療失眠方面都有很好的療效，但是長期看來，病人使用單獨的言語療法更加有益。"認知療法應是首選，"報告主要作者查爾斯。莫寧說，"但很多人都無法獲得。"

    經過培訓能夠治療睡眠問題的醫生，供遠遠大于求，因此網絡療法是"一個非常創新、經濟的失眠療法。"莫寧說。治療失眠的"萬靈丹"可能并不存在，但是這樣前景光明的替代療法應該讓更多的"貓頭鷹"在早上起床的時候，神清氣爽。