Patients with insomnia who implemented cognitive behavioral therapy (CBT) interventions, such as relaxation techniques, had greater improvement in their sleep than patients who received the sleep medication zopiclone, according to a study in the June 28 issue of JAMA.
Borge Sivertsen, PsyD, of the University of Bergen, Norway, and colleagues conducted a randomized controlled trial between January 2004 and December 2005 to compare the short- and long-term clinical efficacy of CBT and the non-benzodiazepine sleep medication zopiclone. 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 [PSG]).
When looking at the PSG testing results, the reasearchers found that the total time spent awake during the night for the CBT group improved significantly more than that of both the placebo group at 6 weeks and the zopiclone group at both 6 weeks and 6 months. The zopiclone group did not differ significantly from the placebo group. Total wake time at 6 weeks was reduced 52% in the CBT group compared with 4% and 16% in the zopiclone and placebo groups on PSG testing, respectively. On average, participants receiving CBT improved their PSG-registered sleep efficiency by 9% at post-treatment, compared with a decline of 1% in the zopiclone group, a difference that the authors stated was both statistically and clinically significant.
Total sleep time measured using both PSG testing and sleep diaries increased significantly in the CBT group at 6 months compared with 6 weeks. The zopiclone group showed no significant change at 6 months on their PSG results, maintaining improvements seen at 6 weeks. Comparing the two active treatment conditions, total wake time, sleep efficiency, and slow-wave sleep were all significantly better in the CBT group than in the zopiclone group as assessed using PSG; total sleep time was not significantly different.
“… the present findings have important implications for the clinical management of chronic primary insomnia in older adults. Given the increasing amount of evidence of the lasting clinical effects of CBT and lack of evidence of long-term efficacy of hypnotics, clinicians should consider prescribing hypnotics only for acute insomnia. At present, CBT-based interventions for insomnia are not widely available in clinical practice, and future research should focus on implementing low-threshold treatment options for insomnia in primary care settings,” the authors write.
