Cognitive behaviour therapy more effective than drug treatment in chronic sleep onset insomnia
Cognitive behaviour therapy (CBT) is more effective than zolpidem in the treatment of insomnia and should be considered as first line treatment.
So says Gregg Jacobs, assistant professor of psychiatry at Harvard medical
school and specialist at a sleep disorders centre. In a trial, his team
investigated 63 young and middle-aged adults with chronic sleep onset
insomnia.
Patients were randomised to CBT, pharmacotherapy with zolpidem, combination
therapy and placebo.
The outcome measures studied included sleep onset latency, sleep efficiency,
total sleep time and daytime functioning. In most measures, CBT was the
most effective intervention. It produced the greatest changes in sleep
onset latency and sleep efficiency, yielded the largest number of “normal” sleepers
after treatment and continued to maintain therapeutic gains at long-term
follow up (to one year).
Combination therapy produced no advantage over CBT alone. Drug treatment
produced only moderate improvements during therapy, with its effects
receding after discontinuation.
“Increased recognition of the efficacy of CBT and more widespread
recommendations for its use could improve the quality of life of a large
number of patients
with insomnia,” the study’s authors conclude (Archives
of Internal Medicine 2004;164:
1888). |
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