NEW YORK (Reuters Health) – In the acute treatment of persistent insomnia, cognitive behavioral therapy (CBT) plus zolpidem is more effective than CBT alone, but in the long-term, outcomes are enhanced if zolpidem is discontinued, new research shows.

CBT and hypnotic agents have both been shown to be useful short-term treatments for persistent insomnia, Dr. Charles M. Morin, from Universite Laval, Quebec, Canada, and colleagues note. However, with either treatment alone, achieving complete remission is uncommon.

The goal of the present study, reported in the Journal of the American Medical Association for May 20, was to determine if combining CBT with a hypnotic drug could improve remission rates.

To do this, the researchers randomly assigned 160 patients to receive CBT with or without zolpidem (10 mg/day) for 6 weeks. This was followed by CBT or no treatment for 6 months for subjects initially treated with CBT alone or by CBT with or without intermittent zolpidem for 6 months for those initially treated with combination therapy.

During the acute phase, both CBT alone and with zolpidem significantly improved sleep latency, time awake after sleep onset, and sleep efficiency. By contrast, only CBT plus zolpidem significantly increased sleep time (p = 0.04).

At 6 weeks, the treatment response and remission rates were comparable with CBT alone and combined with zolpidem, hovering around 60% and 42%, respectively. At 6 months, by contrast, the remission rate in subjects who began with combined treatment and continued on CBT alone was significantly higher than that of subjects who continued combined therapy: 68% vs. 42% (p = 0.04).

“Although the present findings are promising, there is currently no treatment that works for every patient with insomnia and additional studies are needed to develop treatment algorithms to guide practitioners in the clinical management of insomnia,” the authors conclude.

References:
JAMA 2009;301:2005-2015.