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Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia.

Abstract

BACKGROUND

Previous studies of insomnia focused mainly on the improvement of sleep condition and ignored the effects of sleep-related psychological activity and daytime function after pharmacological and behavioral treatments. We compared the clinical effects of both therapies on sleep condition, sleep-related psychological activity and daytime function in chronic insomnia.

METHODS

Seventy-one patients with chronic insomnia were randomly divided into 4 groups and either received cognitive-behavior therapy (CBT, n = 19), pharmacological therapy (PCT, n = 17), CBT plus medication (Combined, n = 18) or placebo (n = 17). The treatments lasted for 8 weeks with follow-ups conducted at 3 and 8 months. On the day after treatment ended, all patients were assessed using a polysomnogram (PSG), a sleep diary and a psychological assessment.

RESULTS

The three active treatments were more effective than placebo at the time the treatments were completed. Subjective sleep-onset latency, sleep efficacy and total sleep time were better in the PCT group than in the CBT group. At the 3-month follow-up, subjective and objective sleep-onset latency, sleep efficacy and total sleep time were better in the CBT group than in both the PCT and the Combined group. At the 8-month follow-up, the CBT group showed a steady comfortable sleep state, while the PCT and Combined groups were gradually returning to the pre-treatment condition. The Combined group showed a variable long-term effect. On the other hand, pre-sleep arousal at nighttime, dysfunctional beliefs about sleep as well as daytime functioning in the CBT group not only improved, but was better than in the other active treatment groups.

CONCLUSION

Medication and Combined therapy produced a short-term effect on chronic insomnia while CBT had a long-term effect of improved sleep-related psychological activity and daytime functioning.

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  • Authors+Show Affiliations

    ,

    Department of Medical Psychology, Peking University Health Science Center, Beijing, PR China. rengangwu66@hotmail.com

    , , ,

    Source

    MeSH

    Adult
    Chronic Disease
    Cognitive Behavioral Therapy
    Combined Modality Therapy
    Culture
    Double-Blind Method
    Female
    Follow-Up Studies
    Health Status
    Humans
    Hypnotics and Sedatives
    Male
    Polysomnography
    Psychology
    Sleep Initiation and Maintenance Disorders
    Social Behavior
    Surveys and Questionnaires
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    16785771

    Citation

    Wu, Rengang, et al. "Comparison of Sleep Condition and Sleep-related Psychological Activity After Cognitive-behavior and Pharmacological Therapy for Chronic Insomnia." Psychotherapy and Psychosomatics, vol. 75, no. 4, 2006, pp. 220-8.
    Wu R, Bao J, Zhang C, et al. Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia. Psychother Psychosom. 2006;75(4):220-8.
    Wu, R., Bao, J., Zhang, C., Deng, J., & Long, C. (2006). Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia. Psychotherapy and Psychosomatics, 75(4), pp. 220-8.
    Wu R, et al. Comparison of Sleep Condition and Sleep-related Psychological Activity After Cognitive-behavior and Pharmacological Therapy for Chronic Insomnia. Psychother Psychosom. 2006;75(4):220-8. PubMed PMID: 16785771.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia. AU - Wu,Rengang, AU - Bao,Jinfeng, AU - Zhang,Chungai, AU - Deng,Jun, AU - Long,Chunling, PY - 2006/6/21/pubmed PY - 2006/12/21/medline PY - 2006/6/21/entrez SP - 220 EP - 8 JF - Psychotherapy and psychosomatics JO - Psychother Psychosom VL - 75 IS - 4 N2 - BACKGROUND: Previous studies of insomnia focused mainly on the improvement of sleep condition and ignored the effects of sleep-related psychological activity and daytime function after pharmacological and behavioral treatments. We compared the clinical effects of both therapies on sleep condition, sleep-related psychological activity and daytime function in chronic insomnia. METHODS: Seventy-one patients with chronic insomnia were randomly divided into 4 groups and either received cognitive-behavior therapy (CBT, n = 19), pharmacological therapy (PCT, n = 17), CBT plus medication (Combined, n = 18) or placebo (n = 17). The treatments lasted for 8 weeks with follow-ups conducted at 3 and 8 months. On the day after treatment ended, all patients were assessed using a polysomnogram (PSG), a sleep diary and a psychological assessment. RESULTS: The three active treatments were more effective than placebo at the time the treatments were completed. Subjective sleep-onset latency, sleep efficacy and total sleep time were better in the PCT group than in the CBT group. At the 3-month follow-up, subjective and objective sleep-onset latency, sleep efficacy and total sleep time were better in the CBT group than in both the PCT and the Combined group. At the 8-month follow-up, the CBT group showed a steady comfortable sleep state, while the PCT and Combined groups were gradually returning to the pre-treatment condition. The Combined group showed a variable long-term effect. On the other hand, pre-sleep arousal at nighttime, dysfunctional beliefs about sleep as well as daytime functioning in the CBT group not only improved, but was better than in the other active treatment groups. CONCLUSION: Medication and Combined therapy produced a short-term effect on chronic insomnia while CBT had a long-term effect of improved sleep-related psychological activity and daytime functioning. SN - 0033-3190 UR - https://www.unboundmedicine.com/medline/citation/16785771/Comparison_of_sleep_condition_and_sleep_related_psychological_activity_after_cognitive_behavior_and_pharmacological_therapy_for_chronic_insomnia_ L2 - https://www.karger.com?DOI=10.1159/000092892 DB - PRIME DP - Unbound Medicine ER -