September 27, 2016 | Da Hee Han, PharmD
Few studies have examined the clinical impact of insomnia therapies on daytime outcomes though daytime functioning impairment is typically the main reason for seeking treatment. Researchers from Canada and Spain evaluated the impact of cognitive-behavior therapy (CBT) alone and in combination with medication, on various outcomes of daytime and psychological functioning.
A total of 160 individuals with chronic insomnia received CBT alone or CBT + zolpidem for an initial 6 weeks followed by an extended 6-month therapy. Patients in the CBT group received maintenance CBT or no additional treatment; those in the combination treatment group continued with CBT + intermittent medication or CBT without medication (taper).
Researchers measured patients' anxiety and depressive symptoms, fatigue, quality of life, and perceived impact of sleep difficulties on various indices of daytime functioning at baseline, after each treatment stage, and at 6-month follow-up.
They found that after acute treatment, significant improvements of fatigue, quality of life (mental component), anxiety, and depression were obtained in the CBT alone group but not in the CBT + medication group. After extended treatment, more improvements were seen for the subcohort receiving extended CBT with no additional treatment and for the subcohort receiving CBT with intermittent medication vs. CBT alone. These improvements were sustained through the 6-month follow-up.