And while we're on the subject of easy questions

A trial, albeit very small, conducted in Norway, compared the drug zopiclone with cognitive-behavioral therapy (CBT) and placebo for adults with insomnia. (Once again, the awesome power of Stayin' Alive is revealed; having grown tired of my ceaseless carping, the good people at JAMA have made this particular article available free to the riff-raff.) The CBT consisted of six individual sessions in which the people learned about factors such as diet, exercise, and alcohol use, light, noise and temperature that affect sleep; were taught to set a schedule for sleeping; taught relaxation techniques, etc.

The drug, zopiclone, is sold inexpensively as a generic medication throughout the world. In the U.S., however, Sepracor got a patent on the active stereoisomer* of zopiclone, and so what is a generic drug everywhere else is an expensive patented medication in the U.S., heavily advertised on television under the brand name Lunesta. Some people who take Lunesta engage in bizarre somnambulant behavior, such as gorging on food or driving while asleep.

In the Norwegian trial, the people who received CBT improved their sleep outcomes at 6 month follow-up, whereas the people who took zopiclone actually slept worse than they did at the beginning.

So, here's your second easy question: Why is Lunesta heavily advertised on television, whereas CBT is not? Bonus question: Your insurer will pay for Lunesta, if your doctor prescribes it. Will they pay for CBT?

* Stereoisomers are forms of a chemical compound which have identical atomic configurations except that they have different arrangements in space, e.g. they may be mirror reflections of each other or be so-called cis-trans isomers, with one or more atoms on the same or opposite sides. Somewhere near the beginning, amino acids with a specific handedness became the stuff of life. Since the chemistry of life has a handedness (by convention, amino acids in living things are called left-handed), many drugs and nutrients that exist in left and right handed forms are active in only one form, but it's easiest to synthesize them without worrying about that. Hence the synthetic Vitamin E, for example, that you buy at the CVS, consists of 50% non-biologically active isomer. So what, just take twice as much. Hence the dosage of Lunesta is half that of zopiclone, otherwise they are completely biologically identical.