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Vol. 75, No. 4, 2006
Issue release date: June 2006
Psychother Psychosom 2006;75:220–228

Comparison of Sleep Condition and Sleep-Related Psychological Activity after Cognitive-Behavior and Pharmacological Therapy for Chronic Insomnia

Wu R. · Bao J. · Zhang C. · Deng J. · Long C.
aDepartment of Medical Psychology, Peking University Health Science Center, bBeijing Institute for Neurosis, Capital University of Medication Science, and cSleep Disorders Center of Beijing Second Hospital, Beijing, P.R. China

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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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  1. Mellinger GD, Balter MB, Uhlenhuth EH: Insomnia and its treatment. Prevalence and correlates. Arch Gen Psychiatry 1985;42:225–232.
  2. Balter MB, Uhlenhuth EH: New epidemiologic findings about insomnia and its treatment. J Clin Psychiatry 1992;53(suppl):34–39.

    External Resources

  3. Stoller MK: Economic effects of insomnia. Clin Ther 1994;16:873–897.
  4. Walsh JK, Engelhardt CL, Hartman PG: The direct economic cost of insomnia; in Nutt D, Mendelson W (eds): Hypnotics and Anxiolytics: Baillière’s Clinical Psychiatry. London, Baillière Tindall, 1995, pp 369–381.
  5. Kupfer DJ, Reynolds CF 3rd: Management of insomnia. N Engl J Med 1997;336:341–346.
  6. Nowell PD, Mazumdar S, Buysse DJ, Dew MA, Reynolds CF, 3rd, Kupfer DJ: Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy. JAMA 1997;278:2170–2177.
  7. Woods JH, Winger G: Current benzodiazepine issues. Psychopharmacology 1995;118:107–115.
  8. Linsen SM, Zitman FG, Breteler MH: Defining benzodiazepine dependence: the confusion persists. Eur Psychiatry 1995;10:306–311.

    External Resources

  9. Staedt J, Stoppe G, Hajak G, Muller-Struck A, Ruther E: Chronic insomnia: what should be done if minor tranquilizers are no longer helpful? Neurol Psychiatry 1995;63:368–372.
  10. National Institute of Mental Health: Consensus conference report: drugs and insomnia – the use of medication to promote sleep. JAMA 1984;251:2410–2414.

    External Resources

  11. Morin CM, Culbert JP, Schwartz SM: Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry 1994;151:1172–1180.
  12. Murtagh DR, Greenwood KM: Identifying effective psychological treatments for insomnia: a meta-analysis. J Consult Clin Psychol 1995;63:79–89.
  13. Engle-Friedman M, Bootzin RR, Hazlewood L, Tsao C: An evaluation of behavioral treatments for insomnia in the older adult. J Clin Psychol 1992;48:77–90.
  14. Friedman L, Bliwise DL, Yesavage JA, Salom SR: A preliminary study comparing sleep restriction and relaxation treatments for insomnia in older adults. J Gerontol 1991;46:1–8.
  15. Lichstein KL, Johnson RS: Relaxation for insomnia and hypnotic medication use in older woman. Psychol Aging 1993;8:103–111.
  16. Morin CM, Azrin NH: Behavioral and cognitive treatments of geriatric insomnia. J Consult Clin Psychol 1988;56:748–753.
  17. Morin CM, Kowatch RA, Barry T, Walton E: Cognitive behavior therapy for late-life insomnia. J Consult Clin Psychol 1993;61:137–146.
  18. National Institutes of Health: NIH releases statement on behavioral and relaxation approaches for chronic pain and insomnia. Am Fam Physician 1996;53:1877–1880.
  19. McClusky HY, Milby JB, Switzer PK, Williams V, Wooten V: Efficacy of behavioral versus triazolam treatment in persistent sleep-onset insomnia. Am J Psychiatry 1991;148:121–126.
  20. Milby JB, Williams V, Hall JN, Khuder S, McGill T, Wooten V: Effectiveness of combined triazolam-behavioral therapy for primary insomnia. Am J Psychiatry 1993;150:1259–1260.
  21. Hauri PJ: Can we mix behavioral therapy with hypnotics when treating insomnia? Sleep 1997;20:1111–1118.
  22. Morin CM, Colecchi C, Stone J, Sood R, Brink D: Behavioral and pharmacological therapies for late-life insomnia. JAMA 1999;281:991–999.
  23. Jacobs GD, Edward F, Stickgold R, Michael W: Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Arch Intern Med 2004;164:1888–1896.
  24. Smith MT, Perlis ML, Park A, Smith MS, Pennington J, Giles DE, Buysse DT: Comparative meta-analysis of pharmacotherapy and behavior therapy for persistent insomnia. Am J Psychiatry 2002;159:5–11.
  25. Waters WF, Adams SG Jr, Binks P, Varnado P: Attention, stress and negative emotion in persistent sleep-onset and sleep-maintenance insomnia. Sleep 1993;16:128–136.
  26. Bonnet MH, Arand DL: Activity, arousal, and the MSLT in patients with insomnia. Sleep 2000;23:205–212.
  27. ICSD – International Classification of Sleep Disorders. Diagnostic and Coding Manual. Diagnostic Classification Steering Committee, Thorpy MJ, chairman. Rochester, American Sleep Disorders Association, 1990.
  28. Reynolds CF III, Kupfer DJ, Buysse DJ, Coble PA, Yeager A: Subtyping DSM-III-R primary insomnia: a literature review by the DSM-IV Work Group on Sleep Disorders. Am J Psychiatry 1991;148:432–438.
  29. Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR: Nonpharmacologic treatment of chronic insomnia. An American Academy of Sleep Medicine review. Sleep 1999;22:1134–1156.
  30. Nicassio PM, Mendlowitz DR, Fussell JJ, Petras L: The phenomenology of the pre-sleep state: the development of the pre-sleep arousal scale. Behav Res Ther 1985;23:263–271.
  31. Morin CM, Stone J, Trinkle D, Mercer J, Remsberg S: Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints. Psychol Aging 1993;8:463–467.
  32. Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193–213.
  33. Edinger JD, Wohlgemuth WK, Radtke RA, Marsh GR, Quillian RE: Does cognitive-behavioral insomnia therapy alter dysfunctional beliefs about sleep? Sleep 2001;24:591–599.
  34. Drake C, Richardson G, Roehrs T, Scofield H, Roth T: Vulnerability to stress-related sleep disturbance and hyperarousal. Sleep 2004;27:285–291.
  35. Winkelman J: A novel combination therapy for primary insomnia. Sleep 2004;27:604–605.

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