What is the efficacy of cognitive-behavioral therapy (CBT) compared to sedative hypnotics for treatment of insomnia?

Updated: Sep 11, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Several randomized trials comparing CBT against hypnotics for primary insomnia have been published. Morin and colleagues compared temazepam with CBT in older patients and found similar short-term effects, but there was continued efficacy after discontinuation of therapy in the CBT group only. A study by Jacobs et al comparing zolpidem with CBT showed continued efficacy for the patients treated with CBT. [68]

A European study by Sivertsen and colleagues showed that CBT was superior to zopiclone (not available in the United States). In fact, zopiclone was found to be no different from placebo on 3 of 4 outcome measures. [74] CBT, on the other hand, reduced total awake time by 52%, improved sleep efficiency, and increased slow-wave sleep. At 6 months, sleep efficiency was still improved with CBT. The limitation of this study was that it consisted of 44 older individuals using zopiclone.

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