Comparison of Sleep Condition and Sleep-Related Psychological Activity after Cognitive-Behavior and Pharmacological Therapy for Chronic Insomnia

Wu, Rengang; Bao, Jingjing; Zhang, Chungai; Deng, Jun; Long, Chunling

doi:10.1159/000092892

Cited by 104 publications

(76 citation statements)

References 55 publications

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“…Findings from such studies generally suggest that combined approaches are slightly more effective than medication alone, but they produce similar benefits when compared to CBT alone. [1][2][3][4][5][6] The literature on long-term outcomes of combined therapies is even more limited, with only two studies having reported follow-up data extending to intervals of 12 months or longer after treatment. One study included 63 adults who were randomized to a six-week treatment involving CBT, zolpidem, combined CBT and zolpidem, or placebo.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Maintenance of Therapeutic Gains Associated With Cognitive-Behavioral Therapy for Insomnia Delivered Alone or Combined With Zolpidem

Beaulieu‐Bonneau

Ivers

Guay

et al. 2017

Sleep

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Study objectives:To document the long-term sleep outcomes at 12 and 24 months after patients with chronic insomnia were treated with cognitive-behavioral therapy (CBT), either singly or combined with zolpidem medication. Methods: Participants were 160 adults with chronic insomnia. They were first randomized for a six-week acute treatment phase involving CBT alone or CBT combined with nightly zolpidem, and randomized for a six-month extended treatment phase involving CBT, no additional treatment, CBT combined with zolpidem as needed, or CBT with zolpidem tapered. This paper reports results of the 12-and 24-month follow-ups on the main outcome measures derived from the Insomnia Severity Index and sleep diaries. Results: Clinical improvements achieved 6 months following the end of treatment were well-maintained in all four conditions, with insomnia remission rates ranging from 48% to 74% at the 12-month follow-up, and from 44% to 63% at the 24-month follow-up. Participants receiving CBT with zolpidem taper in the extended treatment phase had significantly better results than those receiving CBT with continued zolpidem as needed. The magnitude of improvements on sleep diary parameters was similar between conditions, with a slight advantage for the CBT with zolpidem taper condition. The addition of extended CBT did not alter the long-term outcome over improvements obtained during the initial 6-week CBT. Conclusions:The results suggest that CBT for insomnia, when delivered alone or in combination with medication, produce durable sleep improvements up to two years after completion of treatment. These long-term results indicate that even if a combined CBT plus medication approach provide an added benefit immediately after treatment, extending CBT while tapering medication produce better sustained improvements compared to continued use of medication as needed.

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Section: Introductionmentioning

confidence: 99%

Long-Term Maintenance of Therapeutic Gains Associated With Cognitive-Behavioral Therapy for Insomnia Delivered Alone or Combined With Zolpidem

Beaulieu‐Bonneau

Ivers

Guay

et al. 2017

Sleep

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“…[110][111][112] These studies provide a limited assessment of temazepam in that they included small sample sizes of 19, 20, and 34 subjects, respectively. The overall quality of evidence from these studies is moderate.…”

Section: Discussionmentioning

confidence: 99%

“…Meta-analyses for temazepam 15 mg were conducted for SL, TST and sleep quality. Two studies 110,112 were included in the meta-analysis of SL. These showed a reduction in subjective SL which exceeded the threshold for clinical significance.…”

Section: Discussionmentioning

confidence: 99%

0395 Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline

Sateia

Buysse

Krystal

et al. 2017

Sleep

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Introduction:The purpose of this guideline is to establish clinical practice recommendations for the pharmacologic treatment of chronic insomnia in adults, when such treatment is clinically indicated. Unlike previous meta-analyses, which focused on broad classes of drugs, this guideline focuses on individual drugs commonly used to treat insomnia. It includes drugs that are FDA-approved for the treatment of insomnia, as well as several drugs commonly used to treat insomnia without an FDA indication for this condition. This guideline should be used in conjunction with other AASM guidelines on the evaluation and treatment of chronic insomnia in adults. Methods: The American Academy of Sleep Medicine commissioned a task force of four experts in sleep medicine. A systematic review was conducted to identify randomized controlled trials, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, and patient values and preferences. Literature reviews are provided for those pharmacologic agents for which sufficient evidence was available to establish recommendations. The AASM Board of Directors approved the final recommendations. Recommendations:The following recommendations are intended as a guideline for clinicians in choosing a specific pharmacological agent for treatment of chronic insomnia in adults, when such treatment is indicated. Under GRADE, a STRONG recommendation is one that clinicians should, under most circumstances, follow. A WEAK recommendation reflects a lower degree of certainty in the outcome and appropriateness of the patient-care strategy for all patients, but should not be construed as an indication of ineffectiveness. GRADE recommendation strengths do not refer to the magnitude of treatment effects in a particular patient, but rather, to the strength of evidence in published data. Downgrading the quality of evidence for these treatments is predictable in GRADE, due to the funding source for most pharmacological clinical trials and the attendant risk of publication bias; the relatively small number of eligible trials for each individual agent; and the observed heterogeneity in the data. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources.1. We suggest that clinicians use suvorexant as a treatment for sleep maintenance insomnia (versus no treatment) in adults. (WEAK) 2. We suggest that clinicians use eszopiclone as a treatment for sleep onset and sleep maintenance insomnia (versus no treatment) in adults. (WEAK) 3. We suggest that clinicians use zaleplon as a treatment for sleep onset insomnia (versus no treatment) in adults. (WEAK) 4. We suggest that clinicians use zolpidem as a treatment for sleep onset and sleep maintenance in...

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“…Risk of bias was predominantly moderate. 89 Evidence from one small trial was insufficient to draw conclusions regarding the efficacy of multicomponent behavioral interventions in treating insomnia disorder in the general adult population.…”

Section: Overview Of Studiesmentioning

confidence: 99%

“…89,97 One was conducted in Australia 89 and one in Scotland. 97 Studies differed in how the stimulus control was delivered.…”

Section: Overview Of Studiesmentioning

confidence: 99%

Cognitive Behavioral Therapy in the Treatment of Insomnia

Haynes¹,

Talbert²,

Fox³

et al. 2018

Southern Medical Journal

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Comparison of Sleep Condition and Sleep-Related Psychological Activity after Cognitive-Behavior and Pharmacological Therapy for Chronic Insomnia

Cited by 104 publications

References 55 publications

Long-Term Maintenance of Therapeutic Gains Associated With Cognitive-Behavioral Therapy for Insomnia Delivered Alone or Combined With Zolpidem

Long-Term Maintenance of Therapeutic Gains Associated With Cognitive-Behavioral Therapy for Insomnia Delivered Alone or Combined With Zolpidem

0395 Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline

Cognitive Behavioral Therapy in the Treatment of Insomnia

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