Comparison of sleep condition and sleep-related psychological activity after cognitive-behavior and pharmacological therapy for chronic insomnia.
BACKGROUND
Previous studies of insomnia focused mainly on the improvement of sleep condition and ignored the effects of sleep-related psychological activity and daytime function after pharmacological and behavioral treatments. We compared the clinical effects of both therapies on sleep condition, sleep-related psychological activity and daytime function in chronic insomnia.


METHODS
Seventy-one patients with chronic insomnia were randomly divided into 4 groups and either received cognitive-behavior therapy (CBT, n = 19), pharmacological therapy (PCT, n = 17), CBT plus medication (Combined, n = 18) or placebo (n = 17). The treatments lasted for 8 weeks with follow-ups conducted at 3 and 8 months. On the day after treatment ended, all patients were assessed using a polysomnogram (PSG), a sleep diary and a psychological assessment.


RESULTS
The three active treatments were more effective than placebo at the time the treatments were completed. Subjective sleep-onset latency, sleep efficacy and total sleep time were better in the PCT group than in the CBT group. At the 3-month follow-up, subjective and objective sleep-onset latency, sleep efficacy and total sleep time were better in the CBT group than in both the PCT and the Combined group. At the 8-month follow-up, the CBT group showed a steady comfortable sleep state, while the PCT and Combined groups were gradually returning to the pre-treatment condition. The Combined group showed a variable long-term effect. On the other hand, pre-sleep arousal at nighttime, dysfunctional beliefs about sleep as well as daytime functioning in the CBT group not only improved, but was better than in the other active treatment groups.


CONCLUSIONS
Medication and Combined therapy produced a short-term effect on chronic insomnia while CBT had a long-term effect of improved sleep-related psychological activity and daytime functioning.
Wu
Rengang
R
Department of Medical Psychology, Peking University Health Science Center, Beijing, PR China. rengangwu66@hotmail.com
Bao
Jinfeng
J
Zhang
Chungai
C
Deng
Jun
J
Long
Chunling
C
D000328:Adult; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003469:Culture; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D017286:Polysomnography; D011584:Psychology; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy*; D012919:Social Behavior; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives