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.

    睡个好觉，不该这么麻烦。但是据估计，30%的美国成年人都受到失眠困扰--至少有时候是这样。夜幕降临，未必就带来酣睡。

    为应对失眠，2008年美国人花费5000美元购买安必恩等药物，6亿美元购买褪黑素、缬草根等非处方催眠产品。一些人寻求医学或心理疗法，剩下的只能无可奈何，在黑夜中辗转反侧，第二天到来，多灌一杯咖啡，保持清醒状态。

    不管我们付出多大努力，仍有10%的美国仍长期受到失眠困扰（难以入睡，难以保持睡眠）--白天瞌睡，或者因劳累引起效率低下--科学研究人员仍旧在探索这种情况如何造成，应该如何治疗。《睡眠》杂志现在刊登了一项研究，给人们提出了一种治疗失眠的雷人方法：因特网。网络疗法已经用于治疗各种不良习惯和失调，如暴饮暴食、吸烟、压抑--还有失眠。

    相比面授咨询或医学疗法，网络治疗不但更加简单，而且更为经济。蓝十字、安泰等主要健康保健机构甚至会免费提供网络治疗失眠项目。愈来愈多的证据显示，在线治疗真正有效：在《睡眠》新近展开的研究中，完成了为期五周的网络失眠治疗项目的参与者中，81%都称自己睡眠得到了改善。

    "在网络项目中，可能有某些独特之处，比如能够得到真正坐在驾驶座上的感觉。"研究报告作者诺拉。文森特说，这位诊疗心理学家还补充道，40名完成了她的多媒体项目的参与者中，许多非但睡眠质量得到了提高，而且白天疲劳的情况和对照组相比也有所减少。"人们喜欢独立解决问题。我觉得这对他们有激励作用。"她说。

    文森特在认知行为疗法的基础上，在虚拟疗法中结合了影像、文本和音频文件，给失眠者传授良好的睡眠卫生的各个方面，包括在睡前放松身体，在无法马上产生困意时缓解压力。（如果无法入睡最不明智的方法之一就是躺在那里，总想着自己睡不着。）她要求参加者写数字睡眠日记，练习屏幕上展示的技巧。同样，他们还可以下载睡眠治疗师和演员在的一对一疗程中的音频片断，在数字音乐播放器中播放。

    从前研究已经显示网络疗法能够缓解失眠，但是很少有研究将其与其他疗法进行直接比对。而文森特的研究发现，接受网络治疗者中，35%都称自己得到了"很大"或"明显"改善；相比之下，在加拿大曼尼托巴大学文森特的睡眠诊所中使用同样的行为认知疗法，进行现场治疗的病人中，50%称改善较为明显。当然，网络疗法有一个好处：不管是否有机会获得面对面治疗，对病人都能奏效。

    网络疗法的支持者说，这比面授咨询更加有效。"人们不用担心什么个性问题，也不用一遍遍地读材料。" 马萨诸塞大学医学院失眠专家格雷格雅各布说，过去两年中，他推出了一个自导网络项目。病人无需办公室预约，并能按照自己的速度进行，因此网络疗法广泛受众潜力更大。

    但是也有人批评电脑咨询，尤其是电脑无法深入病人失眠根源。"现在计算机能做的也就这么多了。"S.K. 穆斯塔法博士称。穆斯塔法博士在南加利福尼亚州经营先进睡眠医疗服务连锁诊所，曾经在流行减肥真人秀"瘦身达人"中出任睡眠古鲁。穆斯塔法说，网络疗法能够起到教育工具的帮助作用，但也警告："这样你却无法跟一位专家交谈，找出失眠根源。"（失眠可能是某种存在问题的副作用，比如焦虑、阿尔茨海默氏症、风湿、哮喘，或者是其他不好的睡眠习惯--例如睡觉时间不规律--所引发。）文森特承认，对于有着更深程度问题--比如精神压抑、有自杀倾向--或者难以集中注意力的患者，这样的治疗很可能毫无起色。

    随着数字疗法的展开，"其中一个难题就是怎样识别网络疗法会对谁有效。"美国新罕布什尔州黎巴嫩市达特茅斯-希区柯克精神病学协会睡眠医学主管迈克尔。萨蒂伊纳说，"现在的睡眠医学仍旧不成熟，几十年来，这个社会都是把药物治疗作为主体。但是我们已经开始转变这种观念。"最近萨蒂尔纳中心就雇用了一名护师提供经济的集体治疗，用以替代精神病医师的个别咨询。

    认知行为疗法相对药物疗法已经得到了广泛研究。《美国医学会杂志》最近刊登的研究表明，虽然短期看来，单独使用认知疗法，或者将其同药物疗法结合使用在治疗失眠方面都有很好的疗效，但是长期看来，病人使用单独的言语疗法更加有益。"认知疗法应是首选，"报告主要作者查尔斯。莫宁说，"但很多人都无法获得。"

    经过培训能够治疗睡眠问题的医生，供远远大于求，因此网络疗法是"一个非常创新、经济的失眠疗法。"莫宁说。治疗失眠的"万灵丹"可能并不存在，但是这样前景光明的替代疗法应该让更多的"猫头鹰"在早上起床的时候，神清气爽。