What is the efficacy of combined cognitive-behavioral therapy (CBT) and sedative hypnotics for insomnia?

Updated: Sep 11, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Several studies have demonstrated that after 10-24 months’ follow-up, patients in the CBT group demonstrated sustained benefit that was not seen in the combined CBT-hypnotic group. This could be because patients were less willing to practice CBT techniques during the initial phase if they obtained rapid, short-term improvement of sleep with a sedative-hypnotic. In this regard, many sleep experts feel that CBT should be considered as initial therapy for primary insomnia and adjunctive therapy for secondary insomnia.

CBT and hypnotic medications are efficacious for short-term treatment of insomnia, but few patients achieve complete remission with any single treatment. Morin et al studied 160 adults with persistent insomnia and demonstrated that CBT used singly or in combination with zolpidem produced significant improvements in sleep latency, time awake after sleep onset, and sleep efficiency during initial therapy. [75]

Combined therapy produced a higher remission rate than CBT alone during the 6-month extended therapy phase and the 6-month follow-up period (56% vs 43%). Long-term outcome was optimized when medication was discontinued during maintenance CBT. [75]


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