Long-Term Maintenance of Therapeutic Gains Associated With Cognitive-Behavioral Therapy for Insomnia Delivered Alone or Combined With Zolpidem.
Level 2 - randomized trial
Individual randomized controlled trial with long-term follow-up
PubMed 28364426 · doi:10.1093/sleep/zsx002
What was done
A total of 160 adults with chronic insomnia were randomized to a six-week acute treatment phase involving cognitive-behavioral therapy (CBT) alone or CBT combined with nightly zolpidem. They were then randomized to a six-month extended treatment phase of CBT, no additional treatment, CBT with as-needed zolpidem, or CBT with zolpidem tapered. Sleep outcomes were evaluated at 12 and 24 months post-treatment using the Insomnia Severity Index and sleep diaries.
What was found
Insomnia remission rates across all four conditions ranged from 48% to 74% at 12 months and from 44% to 63% at 24 months. Participants receiving CBT with zolpidem taper in the extended phase had significantly better results than those receiving CBT with continued as-needed zolpidem. Sleep diary improvements were of similar magnitude across conditions, with a slight advantage for the taper condition. Extended CBT did not alter long-term outcomes compared to gains obtained from the initial six-week CBT.
Why it matters
This study demonstrates that sleep improvements from CBT for insomnia persist up to two years. For patients receiving combined behavioral and pharmacological therapy, tapering medication alongside CBT yields better long-term maintenance than continuing as-needed hypnotic use.
Limits
The abstract omits exact numerical remission rates for individual subgroups, statistical effect sizes, confidence intervals, and follow-up attrition rates. Findings are limited to zolpidem and may not generalize to other classes of hypnotic agents.
Cited by
- supports Cognitive behavioral therapy for insomnia (CBT-I) is as effective as sleeping pills in the short term and more efficacious in the long term, with sustained sleep benefits after therapy concludes.