![]() ![]() 12, 13 Furthermore, zolpidem does not accumulate during repeated administration, causes minimal disruption of sleep architecture, has lowered potential for abuse due to more selective binding properties at GABA receptor subtypes, and is the most commonly prescribed sedative-hypnotic. Zolpidem tartrate was used for this study based on its documented efficacy, short half-life (2.4 hours) with no active metabolite, rapid onset of action of 30 minutes, and minimal residual effects. The purpose of the present study is to directly compare the separate and combined efficacy of CBT and pharmacotherapy in a placebo-controlled clinical trial that involved young and middle-aged adults with sleep-onset insomnia. To our knowledge, only one well-designed randomized controlled trial 10, 11 has directly compared pharmacotherapy to cognitive behavior therapy (CBT), and no studies have directly compared the efficacy of CBT and pharmacotherapy for sleep-onset insomnia, which is experienced as a primary or secondary sleep complaint by a significant percentage of patients with insomnia, particularly young and middle-aged adults. 4 Before stronger recommendations can be made about the role of drug therapy in the treatment of chronic insomnia, longitudinal data from controlled clinical trials are needed to evaluate the effects of medication beyond the short-term treatment phase. 9 Furthermore, there is no evidence that treatment effects persist on termination of pharmacotherapy. 4 - 8Īlthough the short-term effects of pharmacotherapy are well documented and indicate that it produces moderate treatment between-group effect sizes (Cohen d = 0.56 for sleep-onset latency), the intermediate to long-term benefits are unknown, since the duration of treatment studies averages 7 days with no long-term follow-up. 4 However, long-term use of sedative-hypnotics is contraindicated due to moderate treatment efficacy and adverse effects that can outweigh benefits, including habituation, dependency, impairment of daytime psychomotor and cognitive performance, daytime drowsiness, iatrogenic sleep disturbance, rebound insomnia, and rapid eye movement (REM) sleep rebound. ![]() Pharmacotherapy is the most frequently recommended intervention for insomnia. ![]() 1, 2 In the National Sleep Foundation's 2002 Sleep in America poll, 3 35% of adults reported experiencing symptoms of insomnia every night and 58% reported insomnia at least a few nights per week. Insomnia, defined as difficulty initiating or maintaining sleep with impaired daytime functioning attributed to poor sleep, is one of the most common complaints brought to a physician's office practice. Increased recognition of the efficacy of CBT and more widespread recommendations for its use could improve the quality of life of a large numbers of patients with insomnia. The combined treatment provided no advantage over CBT alone, whereas pharmacotherapy produced only moderate improvements during drug administration and returned measures toward baseline after drug use discontinuation.Ĭonclusions These findings suggest that young and middle-age patients with sleep-onset insomnia can derive significantly greater benefit from CBT than pharmacotherapy and that CBT should be considered a first-line intervention for chronic insomnia. Results In most measures, CBT was the most sleep effective intervention it produced the greatest changes in sleep-onset latency and sleep efficiency, yielded the largest number of normal sleepers after treatment, and maintained therapeutic gains at long-term follow-up. The main outcome measures were sleep-onset latency as measured by sleep diaries secondary measures included sleep diary measures of sleep efficiency and total sleep time, objective measures of sleep variables (Nightcap sleep monitor recorder), and measures of daytime functioning. Interventions included cognitive behavior therapy (CBT), pharmacotherapy, or combination therapy compared with placebo. Methods This was a randomized, placebo-controlled clinical trial that involved 63 young and middle-aged adults with chronic sleep-onset insomnia. The objective of this study was to evaluate the clinical efficacy of behavioral and pharmacological therapy, singly and in combination, for chronic sleep-onset insomnia. Although behavioral and pharmacological therapies have been shown to be effective for insomnia, no placebo-controlled trials have evaluated their separate and combined effects for sleep-onset insomnia. Shared Decision Making and Communicationīackground Chronic sleep-onset insomnia is a prevalent health complaint in adults.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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