CBT has long-term effect on insomnia

Sleep disturbance - Study finds cognitive behavioural therapy as effective as zolpidem.

Undergoing cognitive behavioural therapy (CBT) could lead to long-term improvements in sleep quality among insomnia sufferers, say Canadian researchers.

Treatment with hypnotic drugs, such as zolpidem, is recommended by NICE, but often only achieves short-term relief from insomnia.

For this study, the researchers evaluated the use of CBT on its own and in combination with zolpidem in 160 patients, with an average age of 50, who had persistent insomnia.

The patients were randomly assigned to receive CBT or CBT plus 10mg a day of zolpidem for an initial six weeks, followed by extended six-month therapy.

The CBT included recommendations to restrict the time in bed to the actual time slept and gradually increasing it back to an optimal sleep time.

The patients were asked to keep daily sleep diaries during the study, and were monitored for seven nights of sleep laboratory evaluation.

Overall, the researchers found that CBT used on its own or in combination with zolpidem lowered the amount of time it took to fall asleep and improved sleep efficiency during the initial six weeks of therapy.

But the best long-term outcomes were seen in patients treated solely with CBT. These patients had higher remission rates (68 per cent) compared with patients receiving combined therapy (42 per cent).

The researchers, led by Dr Charles Morin from the University of Laval, Quebec, concluded: '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.'

sanjay.tanday@haymarket.com

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