Cognitive behavioral therapy for treatment of chronic primary insomnia - Arandomized controlled trial

Context Use of nonpharmacological behavioral therapy has been suggested for treatment of chronic primary insomnia, but well-blinded, placebo-controlle d trials demonstrating effective behavioral therapy for sleep-maintenance i nsomnia are lacking. Objective To test the efficacy of a hybrid cognitive behavioral therapy (CB T) compared with both a first-generation behavioral treatment and a placebo therapy for treating primary sleep-maintenance insomnia. Design and Setting Randomized, double-blind, placebo-controlled clinical tr ial conducted at a single academic medical center, with recruitment from Ja nuary 1995 to Patients Seventy-five adults (n = 35 women; mean age, 55.3 years) with chro nic primary sleep-maintenance insomnia (mean duration of symptoms, 13.6 yea rs). Interventions Patients were randomly assigned to receive CBT (sleep educati on, stimulus control, and time-in-bed restrictions; n = 25), progressive mu scle relaxation training (RT; n = 25), ora quasi-desensitization (placebo) treatment (n = 25). Outpatient treatment lasted 6 weeks, with follow-up con ducted at 6 months. Main Outcome Measures Objective (polysomnography) and subjective (steep log ) measures of total sleep time, middle and terminal wake time after sleep o nset (WASO), and sleep efficiency; questionnaire measures of global insomni a symptoms, sleep related self-efficacy, and mood. Results Cognitive behavioral therapy produced larger improvements across th e majority of outcome measures than did RT or placebo treatment. For exampl e, sleep logs showed that CBT-treated patients achieved an average 54% redu ction in their WASO whereas RT-treated and placebo-treated patients, respec tively, achieved only 16% and 12% reductions in this measure. Recipients of CBT also showed a greater normalization of sleep and subjective symptoms t han did the other groups with an average sleep time of more than 6 hours, m iddle WASO of 26.6 minutes, and sleep efficiency of 85.1%. In contrast, RT- treated patients continued to report a middle WASO of 43.3 minutes and slee p efficiency of 78.8%. Conclusions Our results suggest that CBT represents a viable intervention f or primary sleep-maintenance insomnia. This treatment leads to clinically s ignificant sleep improvements within 6 weeks and these improvements appear to endure through 6 months of follow-up.