Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial.

Abstract

CONTEXT:

Insomnia is a common condition in older adults and is associated with a number of adverse medical, social, and psychological consequences. Previous research has suggested beneficial outcomes of both psychological and pharmacological treatments, but blinded placebo-controlled trials comparing the effects of these treatments are lacking.

OBJECTIVE:

To examine short- and long-term clinical efficacy of cognitive behavioral therapy (CBT) and pharmacological treatment in older adults experiencing chronic primary insomnia.

DESIGN, SETTING, AND PARTICIPANTS:

A randomized, double-blinded, placebo-controlled trial of 46 adults (mean age, 60.8 y; 22 women) with chronic primary insomnia conducted between January 2004 and December 2005 in a single Norwegian university-based outpatient clinic for adults and elderly patients.

INTERVENTION:

CBT (sleep hygiene, sleep restriction, stimulus control, cognitive therapy, and relaxation; n = 18), sleep medication (7.5-mg zopiclone each night; n = 16), or placebo medication (n = 12). All treatment duration was 6 weeks, and the 2 active treatments were followed up at 6 months.

MAIN OUTCOME MEASURES:

Ambulant clinical polysomnographic data and sleep diaries were used to determine total wake time, total sleep time, sleep efficiency, and slow-wave sleep (only assessed using polysomnography) on all 3 assessment points.

RESULTS:

CBT resulted in improved short- and long-term outcomes compared with zopiclone on 3 out of 4 outcome measures. For most outcomes, zopiclone did not differ from placebo. Participants receiving CBT improved their sleep efficiency from 81.4% at pretreatment to 90.1% at 6-month follow-up compared with a decrease from 82.3% to 81.9% in the zopiclone group. Participants in the CBT group spent much more time in slow-wave sleep (stages 3 and 4) compared with those in other groups, and spent less time awake during the night. Total sleep time was similar in all 3 groups; at 6 months, patients receiving CBT had better sleep efficiency using polysomnography than those taking zopiclone.

CONCLUSION:

These results suggest that interventions based on CBT are superior to zopiclone treatment both in short- and long-term management of insomnia in older adults.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT00295386.

• Authors: Børge Sivertsen, Siri Omvik, Ståle Pallesen, Bjørn Bjorvatn, Odd E Havik, Gerd Kvale, Geir Høstmark Nielsen, Inger Hilde Nordhus
• Journal: JAMA (JAMA) Vol. 295 Issue 24 Pg. 2851-8 (Jun 28 2006) ISSN: 1538-3598 [Electronic] United States
• PMID: 16804151 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Azabicyclo Compounds
• Hypnotics and Sedatives
• Piperazines
• zopiclone

Topics

• Aged
• Azabicyclo Compounds
• Chronic Disease
• Cognitive Behavioral Therapy
• Double-Blind Method
• Female
• Humans
• Hypnotics and Sedatives (therapeutic use)
• Male
• Middle Aged
• Piperazines (therapeutic use)
• Polysomnography
• Sleep Initiation and Maintenance Disorders (therapy)