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


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.

Download full-text


Available from: Børge Sivertsen
    • "The most widely used non-pharmacological intervention is cognitive behavioral therapy for the treatment of insomnia (CBT-I), a psychotherapeutic approach (Sivertsen et al., 2006). CBT-I has several components, including stimulus control, sleep hygiene education, relaxation training, cognitive restructuring, and sleep restriction. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Sleep disturbance, including insomnia, is a major health issue among both adults and adolescents. Mindfulness-based interventions (MBIs) have recently received increased attention as a non-pharmacological treatment option for patients with insomnia. Objectives: This meta-analysis assesses the effects of MBIs on sleep disturbance in the general population. Methods: A literature search was conducted using PubMed, Medline, PsychInfo, Google Scholar, and Cochrane library. The search terms were “mindfulness therapy”, “mindfulness based cognitive therapy”, “mindfulness based stress reduction”, “acceptance and commitment therapy”, and “yoga” crossed by “insomnia”, “adults”, “adolescents”, or “children”. All studies in English-language were examined through October 2013. Sixteen studies from different age groups were included in this meta-analysis. Sleep measurements were evaluated before and after MBIs, using both subjective as well as objective methods. Long-term effects were also examined. Results: The meta-analysis included 575 individuals across 16 studies. Ages ranged from 8-87 years and 82.09% of participants were female (472/575). MBIs were associated with increased sleep efficiency (SE; ES = 0.88; p < 0.0001) and total sleep time (TST; ES = 0.47; p = 0.003) as assessed by sleep log. Additionally, wake after sleep onset and sleep onset latency decreased (WASO; ES = -0.84; p < 0.0001; SOL; ES = -0.55; p < 0.00001). Changes in sleep when measured by polysomnography and actigraphy, however, were not statistically significant. Sleep improvements as assessed by sleep log continued 2-6 months following treatment initiation. Interpretation is limited by the small number of studies on MBIs for insomnia, especially in adolescent populations. Conclusion: This meta-analysis suggests efficacy of mindfulness-based interventions for improving sleep, as assessed by subjective sleep logs but not by objective measures, and this continued several months after treatment initiation. More research is needed to explore this promising treatment option for adults and adolescents with insomnia.
    No preview · Article · May 2015 · Adolescent psychiatry
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jan 2015 · Open Journal of Medical Psychology
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jun 2014 · Sleep Medicine
Show more