Question:
Insomnia and cognitive therapy - 2 ?
Answer:
Behavior Therapy Compared with Drug Therapy for Insomnia
Studies suggest that fewer than 15 percent of patients with chronic
insomnia receive treatment. Those who receive treatment are often given
drug therapy. Short-term therapy with hypnotic agents is generally
useful for treatment of acute insomnia, but little information is
available on the long-term efficacy of this form of therapy. Morin and
colleagues conducted a randomized controlled trial to compare the
efficacy of behavioral therapy, drug therapy and a combination of the
two in the treatment of chronic insomnia in older adults.
The 72 patients in the two-year study were at least 55 years old (mean
age: 65 years) and had at least a six-month history of difficulty
initiating sleep (sleep-onset latency of at least 30 minutes three or
more times per week) or maintaining sleep (waking for at least 30
minutes after sleep had begun for at least three nights per week).
Polysomnography was performed before treatment was started to ensure
that another sleep disorder was not contributing to the insomnia.
Patients were randomized to receive placebo, cognitive-behavior
therapy, drug therapy, or a combination of behavior and drug therapy.
Cognitive-behavior therapy consisted of eight weekly 90-minute small
group sessions that contained behavior, educational and cognitive
elements. Drug therapy was initiated with 7.5 mg of temazepam at
bedtime, taken at least twice a week but up to every night if
necessary. The dosage was increased as needed to a maximum of 30 mg
nightly. Patients who received tamezepam met once a week with a
physician to discuss medication management. Patients in the combination
therapy group received both temazepam and behavior therapy.
Data from the patients' sleep diaries revealed that the time awake
after sleep onset, sleep efficiency, total wake time and total sleep
time were significantly more improved in all three treatment groups
compared with the placebo group. After two years' follow-up, patients
who received either cognitive-behavior therapy or combination therapy
rated themselves as significantly less impaired than those who received
drug therapy alone or placebo. Follow-up results showed that behavior
therapy yielded the most durable improvements in sleep patterns. Drug
therapy gradually lost its clinical benefits over time.
The authors conclude that cognitive-behavior therapy that includes
patient education about proper sleep hygiene effectively produces both
short-term and long-term improvements in insomnia. While drug therapy
may take less time to institute in the short run, it is probably not
adequate as sole treatment for the long-term management of chronic
insomnia.
