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Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison.
Arch Intern Med 2004; 164(17):1888-96AI

Abstract

BACKGROUND

Chronic sleep-onset insomnia is a prevalent health complaint in adults. 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. 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.

METHODS

This was a randomized, placebo-controlled clinical trial that involved 63 young and middle-aged adults with chronic sleep-onset insomnia. Interventions included cognitive behavior therapy (CBT), pharmacotherapy, or combination therapy compared with placebo. 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.

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 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.

CONCLUSIONS

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. 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.

Authors+Show Affiliations

Sleep Disorders Center, Beth Israel Deaconess Medical Center, Laboratory of Neurophysiology, Harvard Medical School, Boston, MA 02215, USA. gjacobs@caregroup.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15451764

Citation

Jacobs, Gregg D., et al. "Cognitive Behavior Therapy and Pharmacotherapy for Insomnia: a Randomized Controlled Trial and Direct Comparison." Archives of Internal Medicine, vol. 164, no. 17, 2004, pp. 1888-96.
Jacobs GD, Pace-Schott EF, Stickgold R, et al. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med. 2004;164(17):1888-96.
Jacobs, G. D., Pace-Schott, E. F., Stickgold, R., & Otto, M. W. (2004). Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Archives of Internal Medicine, 164(17), pp. 1888-96.
Jacobs GD, et al. Cognitive Behavior Therapy and Pharmacotherapy for Insomnia: a Randomized Controlled Trial and Direct Comparison. Arch Intern Med. 2004 Sep 27;164(17):1888-96. PubMed PMID: 15451764.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. AU - Jacobs,Gregg D, AU - Pace-Schott,Edward F, AU - Stickgold,Robert, AU - Otto,Michael W, PY - 2004/9/29/pubmed PY - 2005/2/18/medline PY - 2004/9/29/entrez SP - 1888 EP - 96 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 164 IS - 17 N2 - BACKGROUND: Chronic sleep-onset insomnia is a prevalent health complaint in adults. 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. 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. METHODS: This was a randomized, placebo-controlled clinical trial that involved 63 young and middle-aged adults with chronic sleep-onset insomnia. Interventions included cognitive behavior therapy (CBT), pharmacotherapy, or combination therapy compared with placebo. 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. 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 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. CONCLUSIONS: 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. 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. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/15451764/Cognitive_behavior_therapy_and_pharmacotherapy_for_insomnia:_a_randomized_controlled_trial_and_direct_comparison_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.164.17.1888 DB - PRIME DP - Unbound Medicine ER -