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Counseling better than pills for insomnia

Cognitive behavioral therapy (CBT), a counseling method that emphasizes the role of thinking and behavior modification, may be more effective than drugs for chronic insomnia.
/ Source: Reuters

Cognitive behavioral therapy (CBT), a counseling method that emphasizes the role of thinking and behavior modification, is more effective than zopiclone for the short- and long-term treatment of chronic insomnia in older adults, according to a new report. In fact, the study found that zopiclone was no more effect for insomnia than placebo was (a sugar pill.)

Zopiclone, sold under the trade name Imovane, is a central nervous system depressant. To prevent excessive drowsiness while using zopiclone, other CSN depressants, such as alcohol, should be avoided. Side effects that may particularly affect the elderly are confusion, unsteadiness and poor coordination.

Several studies have suggested that psychological and pharmacological interventions can improve insomnia, yet few studies have actually compared the two, Dr. Borge Sivertsen, from the University of Bergen in Norway, and colleagues note.

As reported in the Journal of the American Medical Association, the researchers assessed sleep outcomes in 46 insomnia patients, at least 55 years of age, who were randomly assigned to CBT, zopiclone or a placebo. The subjects were treated for 6 weeks and were followed for up to 6 months.

The features of CBT, which was conducted in weekly 50-minute sessions, included education about lifestyle factors that influence sleep, such as the importance of maintaining a strict sleep schedule and using the bedroom only when sleepy. The subjects were also taught to recognize and correct sleep misconceptions and how to perform progressive relaxation techniques.

After CBT, the percentage of time in bed actually spent sleeping, also referred to as sleep efficiency, increased from 81.4 percent at the beginning of the study to 90.1 percent at 6-month follow-up. By contrast, with zopiclone treatment, sleep efficiency actually worsened slightly, dropping from 82.3 percent to 81.9 percent.

Patients treated with CBT spent more time in the deepest stages of sleep and less time awake at night compared with patients in the zopiclone and placebo groups.

For most outcomes, zopiclone did no better than placebo, the authors point out.

These results suggest that CBT is superior to zopiclone for treating chronic insomnia in older adults, the authors conclude. They also suggest that future studies should try to identify the factors in the CBT regimen that produce the best results and if CBT sessions need to be repeated to maintain the improvements.