Cognitive behavior therapy appears beneficial for long-term treatment of insomnia

May 19, 2009

For patients with persistent insomnia, a combination of cognitive behavior therapy (CBT) and the medication zolpidem for 6 weeks was associated with improvement in sleep, although for a longer treatment period CBT alone was more beneficial, according to a study in the May 20 issue of JAMA.

Insomnia is a prevalent public health problem affecting large segments of the population on a situational, recurrent, or chronic basis. "Persistent insomnia is associated with significant impairments of daytime functioning, reduced quality of life, and when persistent insomnia is not treated, it heightens the risks for major and ," the authors write. CBT and some medications are effective for short-term treatment of insomnia, but few patients achieve complete remission with any single treatment. It has been unclear whether combined therapies would improve outcomes.

Charles M. Morin, Ph.D., of the Universite Laval, Quebec, Canada, and colleagues evaluated the short- and long-term effects of CBT, singly and combined with the medication zolpidem, for persistent insomnia, and compared treatment strategies to optimize long-term outcomes. The trial included 160 adults, who were randomized to receive either CBT alone or CBT plus 10 mg/d (taken at bedtime) of zolpidem for an initial 6-week therapy, followed by extended 6-month therapy. The CBT included recommendations on how to improve sleep and education regarding faulty beliefs and misconceptions about sleep.

The researchers found that CBT used singly or in combination with zolpidem produced significant improvements in the amount of time that it took to fall asleep, time awake after falling to sleep, and sleep efficiency during initial therapy. A larger increase of sleep time was obtained with the combined approach. After six weeks, the proportion of patients who responded to treatment of CBT alone (60 percent) or CBT plus zolpidem (61 percent) were similar, as were treatment remissions (39 percent for the CBT alone group; 44 percent for the CBT plus zolpidem group).

"The best long-term outcome was obtained with patients treated with combined therapy initially, followed by CBT alone, as evidenced by higher remission rates at the six-month follow-up compared with patients who continued to take zolpidem during extended therapy (68 percent vs. 42 percent)," the authors write.

"Although the present findings are promising, there is currently no treatment that works for every patient with insomnia and additional studies are needed to develop treatment algorithms to guide practitioners in the clinical management of insomnia."

More information: JAMA. 2009;301[19]:2005-2015.

Source: JAMA and Archives Journals (news : web)

Explore further: Haiti cholera outbreak kills 132 in 2014

add to favorites email to friend print save as pdf

Related Stories

CBT and BT: Some effect against chronic pain

Apr 15, 2009

Cognitive Behaviour Therapy (CBT) and Behaviour Therapy (BT) show some effect in helping the disability associated with chronic pain, according to a Cochrane Systematic Review. The researchers assessed the use of CBT and ...

Insomnia often appears to be a persistent condition

Mar 09, 2009

About three-fourths of individuals with insomnia report experiencing the condition for at least one year and almost half experience it for three years, according to a report in the March 9 issue of Archives of Internal Me ...

Recommended for you

Ebola vaccine promising in first human trials

3 hours ago

Researchers say they are one step closer to developing an Ebola vaccine, with a Phase 1 trial showing promising results, but it will be months at the earliest before it can be used in the field.

At one month, US Ebola monitors finding no cases

6 hours ago

The U.S. program that requires weeks of monitoring for travelers from African countries with Ebola reaches the one-month mark Thursday. And so far, no cases of the disease have turned up.

EU calls for 5,000 doctors to fight Ebola

7 hours ago

The European Commission called for 5,000 doctors to be sent from EU states to combat west Africa's Ebola epidemic, a European source with knowledge of the matter said on Wednesday.

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.