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Randomized Controlled Trial
. 2013 Dec;51(12):787-96.
doi: 10.1016/j.brat.2013.09.006. Epub 2013 Sep 26.

Psychological treatment of hypnotic-dependent insomnia in a primarily older adult sample

Kenneth L Lichstein  1 , Sidney D Nau, Nancy M Wilson, R Neal Aguillard, Kristin W Lester, Andrew J Bush, Christina S McCrae
Affiliations
Randomized Controlled Trial

Psychological treatment of hypnotic-dependent insomnia in a primarily older adult sample

Kenneth L Lichstein et al. Behav Res Ther. 2013 Dec.

Abstract

Objective: This study tested cognitive behavior therapy (CBT) in hypnotic-dependent, late middle-age and older adults with insomnia.

Method: Seventy volunteers age 50 and older were randomized to CBT plus drug withdrawal, placebo biofeedback (PL) plus drug withdrawal, or drug withdrawal (MED) only. The CBT and PL groups received eight, 45 min weekly treatment sessions. The drug withdrawal protocol comprised slow tapering monitored with about six biweekly, 30 min sessions. Assessment including polysomnography (PSG), sleep diaries, hypnotic consumption, daytime functioning questionnaires, and drug screens collected at baseline, posttreatment, and 1-year follow-up.

Results: Only the CBT group showed significant sleep diary improvement, sleep onset latency significantly decreased at posttreatment. For all sleep diary measures for all groups, including MED, sleep trended to improvement from baseline to follow-up. Most PSG sleep variables did not significantly change. There were no significant between group differences in medication reduction. Compared to baseline, the three groups decreased hypnotic use at posttreatment, down 84%, and follow-up, down 66%. There was no evidence of withdrawal side-effects. Daytime functioning, including anxiety and depression, improved by posttreatment. Rigorous methodological features, including documentation of strong treatment implementation and the presence of a credible placebo, elevated the confidence due these findings.

Conclusions: Gradual drug withdrawal was associated with substantial hypnotic reduction at posttreatment and follow-up, and withdrawal side-effects were absent. When supplemented with CBT, participants accrued incremental self-reported, but not PSG, sleep benefits.

Keywords: Cognitive behavior therapy; Drug withdrawal; Hypnotic dependence; Insomnia.

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Figures

Figure 1
Figure 1
CONSORT participant flow diagram.
Figure 2
Figure 2
Sleep diary sleep onset latency changes by phase and treatment condition.
Figure 3
Figure 3
Self-reported medication consumption by phase and treatment condition.
See this image and copyright information in PMC

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