Cognitive Behavioral Therapy vs Zopiclone for Treatment of Chronic Primary Insomnia in Older Adults

Department of Clinical Psychology, University of Bergen, Bergen, Hordaland, Norway
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 07/2006; 295(24):2851-8. DOI: 10.1001/jama.295.24.2851
Source: PubMed

ABSTRACT Insomnia is a common condition in older adults and is associated with a number of adverse medical, social, and psychological consequences. Previous research has suggested beneficial outcomes of both psychological and pharmacological treatments, but blinded placebo-controlled trials comparing the effects of these treatments are lacking.
To examine short- and long-term clinical efficacy of cognitive behavioral therapy (CBT) and pharmacological treatment in older adults experiencing chronic primary insomnia.
A randomized, double-blinded, placebo-controlled trial of 46 adults (mean age, 60.8 y; 22 women) with chronic primary insomnia conducted between January 2004 and December 2005 in a single Norwegian university-based outpatient clinic for adults and elderly patients.
CBT (sleep hygiene, sleep restriction, stimulus control, cognitive therapy, and relaxation; n = 18), sleep medication (7.5-mg zopiclone each night; n = 16), or placebo medication (n = 12). All treatment duration was 6 weeks, and the 2 active treatments were followed up at 6 months.
Ambulant clinical polysomnographic data and sleep diaries were used to determine total wake time, total sleep time, sleep efficiency, and slow-wave sleep (only assessed using polysomnography) on all 3 assessment points.
CBT resulted in improved short- and long-term outcomes compared with zopiclone on 3 out of 4 outcome measures. For most outcomes, zopiclone did not differ from placebo. Participants receiving CBT improved their sleep efficiency from 81.4% at pretreatment to 90.1% at 6-month follow-up compared with a decrease from 82.3% to 81.9% in the zopiclone group. Participants in the CBT group spent much more time in slow-wave sleep (stages 3 and 4) compared with those in other groups, and spent less time awake during the night. Total sleep time was similar in all 3 groups; at 6 months, patients receiving CBT had better sleep efficiency using polysomnography than those taking zopiclone.
These results suggest that interventions based on CBT are superior to zopiclone treatment both in short- and long-term management of insomnia in older adults. Identifier: NCT00295386.

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Available from: Børge Sivertsen, Sep 25, 2015
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    • "CBTI and similar interventions produce reliable changes in several sleep parameters of individuals with either primary insomnia or insomnia associated with medical and psychiatric disorders [11]. For older adults, CBTI can provide greater and more prolonged beneficial effects than sleep medications [12]. It was found that a form of short-term CBTI dubbed brief behavioral therapy was effective for the treatment of sleep disturbance and mood symptoms in cases of residual depression [13]. "
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    ABSTRACT: Several reports suggest that college students often have atypical sleep patterns and experience poor sleep quality. We examined the effect of a cognitive behavioral therapy (CBT) based intervention program to improve sleep quality and overall mental health among college students. The intervention was delivered in the form of e-mail newsletters. Fifty-three students participated in the intervention group, and another 50 students participated in the control group. The intervention group received a lecture on sleep hygiene; once-weekly e-mail newsletters on sleep health topics (sleep hygiene, stimulus control, sleep restriction, sleep titration, and relapse prevention) and were asked to maintain a four-week sleep diary. The Pittsburgh Sleep Quality Index (PSQI), a measure of sleep quality, and the Kessler 6, a measure of psychological distress, were administered before the lecture (as the baseline measurement) and again 16 weeks later (follow-up measurement). PSQI and K6 scores were reduced in the intervention group compared with the control group. A CBT-based sleep health program utilizing e-mail newsletters may work to improve sleep quality and mental health. This program may represent a cost effective way for Japanese students to receive treatment for poor sleep and may also serve to prevent psychiatric problems.
    Open Journal of Medical Psychology 01/2015; 04(01-01):9-16. DOI:10.4236/ojmp.2015.41002
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    • "Whereas each individual treatment option has its own benefits and limitations, investigators have also combined CBT and medication in order to take advantage of their respective strengths and presumably optimize treatment response [9] [10] [11] [12]. Medication is often thought to bring about rapid relief of sleep disturbances, whereas CBT provides more sustained improvements over time. "
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    ABSTRACT: Objectives To examine the speed and trajectory of changes in sleep/wake parameters during short-term treatment of insomnia with cognitive–behavioral therapy (CBT) alone versus CBT combined with medication; and to explore the relationship between early treatment response and post-treatment recovery status. Methods Participants were 160 adults with insomnia (mean age, 50.3 years; 97 women, 63 men) who underwent a six-week course of CBT, singly or combined with 10 mg zolpidem nightly. The main dependent variables were sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, and sleep quality, derived from sleep diaries completed daily by patients throughout the course of treatment. Results Participants treated with CBT plus medication exhibited faster sleep improvements as evidenced during the first week of treatment compared to those receiving CBT alone. Optimal sleep improvement was reached on average after only one week for the combined treatment compared to two to three weeks for CBT alone. Early treatment response did not reliably predict post-treatment recovery status. Conclusions Adding medication to CBT produces faster sleep improvement than CBT alone. However, the magnitude of early treatment response is not predictive of final response after the six-week therapy. Additional research is needed to examine mechanisms involved in this early treatment augmentation effect and its impact on long-term outcome.
    Sleep Medicine 06/2014; 15(6). DOI:10.1016/j.sleep.2014.02.004 · 3.15 Impact Factor
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    • "Several trials have demonstrated that cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for primary insomnia [10]. It can be superior to pharmacological treatment in both short-term and long-term perspectives [11]. Although evidence of the effectiveness of CBT-I has existed for more than 20 years, it has not been introduced to patients who also suffer from bipolar disorder [12]. "
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    ABSTRACT: Patients with bipolar disorder experience sleep disturbance, even in euthymic phases. Changes in sleep pattern are frequent signs of a new episode of (hypo)mania or depression. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment for primary insomnia, but there are no published results on the effects of CBT-I in patients with bipolar disorder. In this randomized controlled trial, we wish to compare CBT-I and treatment as usual with treatment as usual alone to determine its effect in improving quality of sleep, stabilizing minor mood variations and preventing new mood episodes in euthymic patients with bipolar disorder and comorbid insomnia. Patients with euthymic bipolar I or II disorder and insomnia, as verified by the Structured Clinical Interview for DSM Disorders (SCID-1) assessment, will be included. The patients enter a three-week run-in phase in which they complete a sleep diary and a mood diary, are monitored for seven consecutive days with an actigraph and on two of these nights with polysomnography in addition before randomization to an eight-week treatment trial. Treatment as usual consists of pharmacological and supportive psychosocial treatment. In this trial, CBT-I will consist of sleep restriction, psychoeducation about sleep, stabilization of the circadian rhythm, and challenging and correcting sleep state misperception, in three to eight sessions. This trial could document a new treatment for insomnia in bipolar disorder with possible effects on sleep and on stability of mood. In addition, more precise information can be obtained about the character of sleep disturbance in bipolar disorder.Trial registration: NCT01704352.
    Trials 01/2014; 15(1):24. DOI:10.1186/1745-6215-15-24 · 1.73 Impact Factor
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