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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.

Links

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  • Authors+Show Affiliations

    ,

    Department of Clinical Psychology, University of Bergen, Bergen, Norway. borge.sivertsen@psykp.uib.no

    , , , , , ,

    Source

    JAMA 295:24 2006 Jun 28 pg 2851-8

    MeSH

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

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    16804151

    Citation

    Sivertsen, Børge, et al. "Cognitive Behavioral Therapy Vs Zopiclone for Treatment of Chronic Primary Insomnia in Older Adults: a Randomized Controlled Trial." JAMA, vol. 295, no. 24, 2006, pp. 2851-8.
    Sivertsen B, Omvik S, Pallesen S, et al. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA. 2006;295(24):2851-8.
    Sivertsen, B., Omvik, S., Pallesen, S., Bjorvatn, B., Havik, O. E., Kvale, G., ... Nordhus, I. H. (2006). Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA, 295(24), pp. 2851-8.
    Sivertsen B, et al. Cognitive Behavioral Therapy Vs Zopiclone for Treatment of Chronic Primary Insomnia in Older Adults: a Randomized Controlled Trial. JAMA. 2006 Jun 28;295(24):2851-8. PubMed PMID: 16804151.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. AU - Sivertsen,Børge, AU - Omvik,Siri, AU - Pallesen,Ståle, AU - Bjorvatn,Bjørn, AU - Havik,Odd E, AU - Kvale,Gerd, AU - Nielsen,Geir Høstmark, AU - Nordhus,Inger Hilde, PY - 2006/6/29/pubmed PY - 2006/7/11/medline PY - 2006/6/29/entrez SP - 2851 EP - 8 JF - JAMA JO - JAMA VL - 295 IS - 24 N2 - 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. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/16804151/Cognitive_behavioral_therapy_vs_zopiclone_for_treatment_of_chronic_primary_insomnia_in_older_adults:_a_randomized_controlled_trial_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.295.24.2851 DB - PRIME DP - Unbound Medicine ER -